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Objective Nociceptive Assessment in Ventilated ICU Patients: A Feasibility Study Using Pupillometry and the Nociceptive Flexion Reflex
06:04

Objective Nociceptive Assessment in Ventilated ICU Patients: A Feasibility Study Using Pupillometry and the Nociceptive Flexion Reflex

Published on: July 4, 2018

A prospective evaluation of opioid weaning in opioid-dependent pediatric critical care patients

Richard J Berens1, Michael T Meyer, Theresa A Mikhailov

  • 1Department of Anesthesiology, Medical College of Wisconsin, Children's Hospital of Wisconsin, USA. rberens@chw.org

Anesthesia and Analgesia
|March 23, 2006
PubMed

Insights

Opioid-dependent critically ill children can be weaned off medication in 5 days using oral methadone, showing no increased risk of withdrawal symptoms compared to a 10-day wean. This study offers a faster approach to opioid weaning in pediatric intensive care.

Area of Science:

  • Pediatric critical care medicine
  • Pharmacology
  • Neonatal abstinence syndrome

Background:

  • Critically ill children often receive opioid medication for pain and stress management.
  • Prolonged opioid use in pediatric intensive care units (PICU) can lead to opioid dependency.
  • Abrupt cessation of opioids in dependent children can precipitate a withdrawal syndrome.

Purpose of the Study:

  • To compare the efficacy of a 5-day versus a 10-day oral methadone weaning protocol for opioid-dependent children in the PICU.
  • To assess the incidence of opioid withdrawal events requiring rescue medication in both weaning groups.

Main Methods:

  • A prospective, randomized trial was conducted with opioid-dependent children.
  • Participants were assigned to either a 5-day or a 10-day oral methadone weaning schedule.
  • Opioid withdrawal was monitored using neonatal abstinence scores, with rescue medication administered for scores exceeding a defined threshold.

Main Results:

  • No significant difference in the number of agitation events requiring opioid rescue was observed between the 5-day and 10-day weaning groups.
  • The majority of rescue events occurred around days 5 and 6 of the weaning process in both groups.
  • Children had an average opioid exposure of 3 weeks prior to enrollment.

Conclusions:

  • A 5-day oral methadone weaning protocol appears feasible for opioid-dependent children in the PICU.
  • This shorter weaning duration did not result in an increased incidence of withdrawal events requiring rescue.
  • Further follow-up is recommended to monitor for potential delayed withdrawal syndromes after medication cessation.

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