M M Meyer1, R J Berens. 1. Air Force Institute of Technology, Wright-Patterson Air Force Base, Dayton, Ohio, USA. michael.meyer@59mdw.whmc.af.mil
Abstract
OBJECTIVE: To demonstrate the efficacy of a 10-day, single daily dose, enteral methadone weaning protocol for the prevention of opioid withdrawal symptoms in pediatric patients after prolonged fentanyl exposure. DESIGN: Prospective, observational study. SETTING: Twenty-four-bed medical-surgical intensive care unit within a 222-bed pediatric teaching hospital. PATIENTS: Twenty-nine children, aged 1 day to 19.8 yrs, who received methadone to prevent opioid withdrawal after prolonged continuous fentanyl infusion exposure. INTERVENTIONS: Institution of a standardized methadone weaning protocol. MEASUREMENTS AND MAIN RESULTS: All 29 patients had received a continuous fentanyl infusion; duration of exposure was 14.5 +/- 9.2 days, cumulative fentanyl dose was 1.93 +/- 1.53 mg/kg, and peak fentanyl infusion was 9.6 +/- 4.3 microg/kg per hr. Twenty-five (86%) of 29 patients successfully completed the methadone wean in 10 days. Withdrawal complications that required a weaning delay were seen in three patients, and one patient expired before completion. Sixteen patients were discharged to complete their weaning schedule at home without incident. CONCLUSIONS: Opioid withdrawal symptoms in pediatric intensive care unit patients after prolonged fentanyl exposure can be avoided by using an enteral, 10-day, single daily dose methadone weaning protocol.
OBJECTIVE: To demonstrate the efficacy of a 10-day, single daily dose, enteral methadone weaning protocol for the prevention of opioid withdrawal symptoms in pediatric patients after prolonged fentanyl exposure. DESIGN: Prospective, observational study. SETTING: Twenty-four-bed medical-surgical intensive care unit within a 222-bed pediatric teaching hospital. PATIENTS: Twenty-nine children, aged 1 day to 19.8 yrs, who received methadone to prevent opioid withdrawal after prolonged continuous fentanyl infusion exposure. INTERVENTIONS: Institution of a standardized methadone weaning protocol. MEASUREMENTS AND MAIN RESULTS: All 29 patients had received a continuous fentanyl infusion; duration of exposure was 14.5 +/- 9.2 days, cumulative fentanyl dose was 1.93 +/- 1.53 mg/kg, and peak fentanyl infusion was 9.6 +/- 4.3 microg/kg per hr. Twenty-five (86%) of 29 patients successfully completed the methadone wean in 10 days. Withdrawal complications that required a weaning delay were seen in three patients, and one patient expired before completion. Sixteen patients were discharged to complete their weaning schedule at home without incident. CONCLUSIONS: Opioid withdrawal symptoms in pediatric intensive care unit patients after prolonged fentanyl exposure can be avoided by using an enteral, 10-day, single daily dose methadone weaning protocol.
Authors: Allison B Lardieri; Nicholas M Fusco; Shari Simone; L Kyle Walker; Jill A Morgan; Kristine A Parbuoni Journal: J Pediatr Pharmacol Ther Date: 2015 Jan-Feb