Related Experiment Video

Updated: Mar 24, 2026

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

9.4K

Opioid and Benzodiazepine Withdrawal Syndrome in PICU Patients: Which Risk Factors Matter?

Paulo Sérgio Lucas da Silva1, Maria Eunice Reis, Thais Suelotto Machado Fonseca

  • 1Pediatric Intensive Care Unit, Department of Pediatrics, Hospital do Servidor Público Municipal, São Paulo, Brazil (PSLS); Hospital e Maternidade Santa Joana, São Paulo, Brazil (MER); Faculdade de Medicina do ABC, Santo André, Brazil (TSMF); Health Technologies Assessment Center - Federal University of São Paulo, São Paulo, Brazil (MCMF).

Journal of Addiction Medicine
|March 2, 2016
PubMed

Insights

Iatrogenic withdrawal syndrome (IWS) affects 22.6% of critically ill children on prolonged sedation. Early monitoring after 3 days and higher midazolam doses signal increased risk.

Area of Science:

  • Pediatric Intensive Care
  • Pharmacology
  • Critical Care Medicine

Background:

  • Iatrogenic withdrawal syndrome (IWS) is known but understudied in critically ill children.
  • Validated tools for IWS diagnosis and assessment are scarce in this population.
  • Opioid and benzodiazepine exposure are primary causes of IWS.

Purpose of the Study:

  • Determine the incidence rate of IWS in critically ill children.
  • Identify risk factors associated with IWS development.
  • Evaluate the outcomes of pediatric patients experiencing IWS.

Main Methods:

  • Prospective observational study in a pediatric intensive care unit.
  • 137 patients receiving continuous fentanyl and midazolam for ≥3 days were assessed.
  • Sophia Observation Withdrawal Symptoms scale used during sedation weaning.

Main Results:

  • Overall IWS incidence was 22.6%.
  • Higher median peak midazolam dose (≥0.35 mg/kg/h) significantly associated with IWS.
  • IWS patients experienced longer mechanical ventilation, PICU, and hospital stays.

Conclusions:

  • Monitoring for IWS should commence after 3 days of sedation, not 5.
  • Midazolam infusion rates exceeding 0.35 mg/kg/h identify high-risk patients.
  • Early IWS detection and intervention are crucial for improved outcomes.
Abstract

More Related Videos

Behavioral Characterization of Pentylenetetrazole-induced Seizures: Moving Beyond the Racine Scale07:35

Behavioral Characterization of Pentylenetetrazole-induced Seizures: Moving Beyond the Racine Scale

Published on: July 8, 2025

1.7K

Related Concept Videos

CNS Depressants: Barbiturates and Benzodiazepines01:14

CNS Depressants: Barbiturates and Benzodiazepines

CNS depressants include drugs from the category of barbiturates and benzodiazepines. They are valuable medications for managing anxiety disorders and insomnia. Barbiturates, once used to induce and maintain sleep, have been replaced mainly by benzodiazepines due to barbiturate's toxicity, tolerance, and overdose risks. They interact with GABAA receptors, leading to sedation at low doses and potentially coma and death at higher doses. Phenobarbital, a long-acting barbiturate, possesses...
1.6K
Sedatives and Hypnotics Drugs: Benzodiazepines01:19

Sedatives and Hypnotics Drugs: Benzodiazepines

Benzodiazepines have both sedative and hypnotic properties. They include compounds such as diazepam (Valium) and alprazolam (Xanax). Structurally, their cores are similar, consisting of the fusion of a benzene ring and a diazepine ring, but they share a common mechanism of action in the central nervous system (CNS).
Benzodiazepines work by enhancing the effects of the inhibitory neurotransmitter GABA. They bind to the GABAA receptor, increasing its affinity for GABA, which opens chloride...
1.2K
Anxiolytic Drugs: Benzodiazepines and Buspirone01:29

Anxiolytic Drugs: Benzodiazepines and Buspirone

Benzodiazepines are a class of anxiolytic drugs known for their rapid efficacy and high therapeutic-to-lethal dose ratio, but with a potential risk of drug dependence. These drugs are lipophilic, allowing for rapid absorption after oral administration, eventually reaching the central nervous system (CNS). Once in the CNS, benzodiazepines bind to the allosteric site of the GABAA receptor. This binding enhances the inhibitory effects of the neurotransmitter GABA. By doing so, they prevent...
3.0K
Drug Toxicity: Risk factors01:24

Drug Toxicity: Risk factors

Adverse Drug Reactions (ADRs) are potential complications that arise during pharmacotherapy, influenced by multiple risk factors. Age plays a significant role; both neonates and the elderly are at heightened risk due to their respective immature and diminished metabolic and elimination processes. Gender also impacts ADRs, with females experiencing a 1.5 to 1.7-fold greater risk than males, which may be linked to pharmacokinetic, pharmacodynamic, and hormonal differences. Notably, neonates, the...
148
Sedatives and Hypnotics Drugs: Barbiturates01:20

Sedatives and Hypnotics Drugs: Barbiturates

Sedatives and hypnotics encompass a drug class that acts on the central nervous system (CNS) to alleviate anxiety, promote relaxation and induce sleep.These drugs function by amplifying the actions of the neurotransmitter γ-aminobutyric acid (GABA), resulting in reduced neuronal activity. Barbiturates, a subset of sedatives and hypnotics first synthesized in the late 1800s, are categorized into ultra-short, short, intermediate, and long-acting groups based on their duration of effect. A...
1.3K
Parenteral Anesthetics: Overview01:24

Parenteral Anesthetics: Overview

Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
908