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Dosing evaluation of continuous intravenous fentanyl infusions in overweight children: a pilot study

Emily C Gish1, Donald Harrison, Andrew K Gormley

  • 1Department of Pharmacy, Primary Children's Medical Center, Salt Lake City, Utah.

The Journal of Pediatric Pharmacology and Therapeutics : JPPT : the Official Journal of PPAG
|April 6, 2012
PubMed

Insights

Weight-based dosing of continuous intravenous fentanyl in children showed no significant difference in dosage adjustments between overweight/obese and normal-weight groups. Further research is needed for optimal dosing strategies in pediatric intensive care units.

Area of Science:

  • Pediatric Critical Care Medicine
  • Pharmacology
  • Obesity Research

Background:

  • Accurate dosing of continuous intravenous fentanyl is crucial for effective sedation and analgesia in pediatric intensive care units (PICU).
  • The impact of body mass index (BMI) on fentanyl dosing requirements in children remains an area requiring further investigation.

Purpose of the Study:

  • To evaluate the appropriateness of weight-based dosing for continuous intravenous infusion fentanyl in overweight/obese versus normal-weight children admitted to the PICU.
  • To compare the frequency of dosage adjustments needed to achieve adequate sedation between these two groups.

Main Methods:

  • A retrospective pilot study analyzed data from 5- to 12-year-old children in the PICU receiving continuous intravenous fentanyl for at least 4 days.
  • Patients were categorized into overweight/obese (BMI ≥ 85th percentile) and normal-weight (BMI < 85th percentile) groups.
  • Dosage changes, opioid withdrawal symptoms, and concomitant sedative/analgesic use were compared using t tests and chi-square analyses.

Main Results:

  • No statistically significant difference was observed in the number of daily fentanyl dosage changes between the overweight/obese (0.69) and normal-weight (0.92) groups (p=0.16).
  • Opioid withdrawal symptoms occurred in five patients in each group (p=0.71).
  • The overweight/obese group received more concomitant bolus doses, but this difference was not statistically significant.

Conclusions:

  • Current weight-based dosing strategies for continuous intravenous fentanyl appear numerically similar in terms of dosage adjustments and withdrawal symptoms between overweight/obese and normal-weight children.
  • Larger studies are necessary to definitively establish optimal dosing strategies for continuous intravenous infusion fentanyl in pediatric populations with varying BMIs.
Abstract

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