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Occurrence of withdrawal in critically ill sedated children
L Fonsmark1, Y H Rasmussen, P Carl
1Department of Anaesthesiology and Intensive Care, Gentofte Hospital, University of Copenhagen, Gentofte, Denmark.
Insights
High doses of midazolam in sedated children undergoing mechanical ventilation were linked to withdrawal symptoms. Gradual dose reduction or alternative sedatives may help prevent these reactions.
Area of Science:
- Pediatric Critical Care
- Pharmacology
- Intensive Care Medicine
Background:
- Sedation is frequently used in pediatric intensive care units (ICUs) for mechanical ventilation.
- Withdrawal symptoms can occur after discontinuing sedative medications.
- Midazolam is a common sedative used in this population.
Purpose of the Study:
- To determine the incidence of withdrawal symptoms in children sedated for mechanical ventilation.
- To investigate the association between midazolam administration and withdrawal symptoms.
Main Methods:
- Retrospective chart review of 40 children (6 months to 14 years) in a university hospital ICU.
- Data collected on sedative/analgesic types, doses, duration, and withdrawal occurrence.
- Statistical analysis to identify factors associated with withdrawal.
Main Results:
- Withdrawal symptoms were observed in 35% (14/40) of sedated children.
- High total doses of midazolam (>60 mg/kg) were significantly associated with withdrawal.
- The influence of morphine on withdrawal could not be statistically determined.
Conclusions:
- Withdrawal reactions are a concern in pediatric patients receiving prolonged sedation.
- High-dose midazolam is a significant risk factor for withdrawal.
- Consider gradual tapering of sedatives or using longer-acting agents to mitigate withdrawal risks.
Objectives:
To record the number of children with withdrawal symptoms after the administration of sedatives for mechanical ventilation, and to discuss the possible connection with the administration of midazolam.
Design:
Retrospective data collection from case records and charts.
Setting:
Medical and surgical intensive care unit (ICU) in a university hospital.
Patients:
Children 6 months to 14 yrs of age who required sedation for mechanical ventilation (n = 40).
Interventions:
None.
Measurements And Main Results:
Kind and amount of sedatives and analgesics, duration of administration, and occurrence of withdrawal symptoms. The frequency of withdrawal symptoms was 35% (14/40) of the sedated children. A total dose of midazolam of >60 mg/kg was strongly significantly associated with occurrence of withdrawal. Statistical analysis to determine the occurrence of withdrawal associated with the administration of morphine was not possible.
Conclusions:
Signs and symptoms of a withdrawal reaction were observed in several children. The occurrence of withdrawal was statistically related to high doses of midazolam, but it was not possible to determine the influence of morphine. If large doses of midazolam and opioids have been administered, there may be justification for reducing the dose gradually instead of abruptly, or using longer-acting benzodiazepines or opioids on discontinuation of sedation.