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Anesth Analg 2006;102:1045-1050
© 2006 International Anesthesia Research Society
doi: 10.1213/01.ane.0000202395.94542.3e

PEDIATRIC ANESTHESIA

A Prospective Evaluation of Opioid Weaning in Opioid-Dependent Pediatric Critical Care Patients

Richard J. Berens, MD, Michael T. Meyer, MD, Theresa A. Mikhailov, MD, Krista D. Colpaert, RN, Michelle L. Czarnecki, RN, MSN, CPNP, Nancy S. Ghanayem, MD, George M. Hoffman, Deborah J. Soetenga, RN, MSN, CNS, Thomas J. Nelson, RPh, and Steven J. Weisman, MD

Departments of Anesthesiology and Pediatrics, Medical College of Wisconsin, Children’s Hospital of Wisconsin; National Outcomes Center, Children’s Hospital and Health System; Jane B. Pettit Pain and Palliative Care Center, Children’s Hospital of Wisconsin; Department of Nursing, Children’s Hospital of Wisconsin; Department of Pharmacy, Children’s Hospital of Wisconsin, Milwaukee, Wisconsin

Address correspondence and reprint requests to Richard J. Berens, MD, 9000 W Wisconsin Ave MS, 735 Wauwatosa, WI 53226. Address e-mail to rberens{at}chw.org.

Critically ill children are treated with opioid medication in an attempt to decrease stress and alleviate pain during prolonged pediatric intensive care. This treatment plan places children at risk for opioid dependency. Once dependent, children need to be weaned or risk development of a withdrawal syndrome on abrupt cessation of medication. We enrolled opioid-dependent children into a prospective, randomized trial of 5- versus 10-day opioid weaning using oral methadone. Children exposed to opioids for an average of 3 wk showed no difference in the number of agitation events requiring opioid rescue (3 consecutive neonatal abstinence scores >8 every 2 h) in either wean group. Most of the events requiring rescue occurred on day 5 and 6 of the wean in both treatment groups. Patients may be able to be weaned successfully in 5 days once converted to oral methadone, with a follow-up period after medication wean to observe for a delayed withdrawal syndrome.




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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2006 by the International Anesthesia Research Society.