Additional use of methotrimeprazine for treating refractory agitation in pediatric patients

Zwaan, Sanne van der; Blankespoor, Roos J.; Wolters, Anton M.H.; Creten, C.; Leroy, Piet L. J. M.; Schieveld, Jan N. M.

doi:10.1007/s00134-011-2414-y

Cited by 17 publications

(14 citation statements)

References 3 publications

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“…Our patients were not formally assessed for delirium but features that could be compatible with delirium were seen in cases 3, 4 and 6 and improved with LMZ. A potential role for LMZ in delirium has been previously reported [11] and our findings are consistent with this aforementioned success.…”

Section: Discussionsupporting

confidence: 93%

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Levomepromazine for difficult sedation in pediatric intensive care

Snoek

James

Arenas-López

et al. 2015

J Pediatr Intensive Care

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Sedation and analgesia using opioids and benzodiazepines is frequently required in critically ill children to minimize pain and anxiety. In some patients, difficult sedation occurs when tolerance or unacceptable side effects limit the efficacy of conventional analgo-sedative treatment. We describe seven patients (age range 1 to 17 yr) where difficult sedation was successfully managed with enteral levomepromazine (LMZ). LMZ is a neuroleptic antipsychotic agent that exhibits potent analgo-sedative properties without respiratory depression, through non-opioid and non-benzodiazepine pathways. We describe its use in our pediatric intensive care unit to control agitation in patients with known behavioral disorders who frequently pose a significant sedation challenge. We also illustrate its successful use in cases of withdrawal syndrome and delirium, and discuss the association of fever and its distinction from neuroleptic malignant syndrome in two patients. LMZ should be considered as a useful sedative in critically ill children where difficult sedation occurs and conventional agents are exhausted.

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Section: Discussionsupporting

confidence: 93%

“…It is non-addictive thus avoiding tolerance, dependence and withdrawal. Its successful use, via both enteral and IV routes, has been previously reported in critically ill children with refractory agitation despite haloperidol [11]. Similarly, we report success in critically ill children with difficult sedation.…”

Section: Discussionsupporting

confidence: 75%

Levomepromazine for difficult sedation in pediatric intensive care

Snoek

James

Arenas-López

et al. 2015

J Pediatr Intensive Care

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“…It is commonly used in psychiatric emergency wards to treat acute psychosis or mania and to reduce high levels of agitation and aggressiveness [7]. The biological half-life ranges from 16.5 to 77.9 h, it undergoes extensive hepatic metabolism yielding several metabolites, which are excreted through the urine and feces, and only a small fraction was unchanged levomepromazine [8,9].…”

Section: Discussionmentioning

confidence: 99%

Opioid false-positivity in urine drug screening: levomepromazine cross-reactivity

Rodrigues-Silva

Venâncio

2017

Psychiatry and Clinical Psychopharmacology

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“…23 There is also little evidence in the literature regarding the use of levomepromazine in patients who are difficult to sedate: only case reports are available. 24 No PICU reported the need for neuromuscular blockade. The most commonly used method to monitor the depth of neuromuscular blockade is peripheral nerve stimulation with train-of-four monitoring.…”

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confidence: 99%

Sedation and analgesia in patients on mechanical ventilation in pediatric intensive care units in Argentina

Taffarel

Bonetto

Barón

et al. 2018

Arch Argent Pediatr

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Introduction. Children in pediatric intensive care units (PICUs) are exposed to experiencing pain, stress and anxiety due to their disease, treatment or care setting. Adequate sedation and analgesia are key to their care, particularly in patients requiring mechanical ventilation (MV). Objective. To determine the usual practice in sedation and analgesia management in patients requiring MV in PICUs in Argentina. Material and methods. Descriptive, crosssectional, multi-center study conducted by means of e-mailed surveys. Results. A total of 45 PICUs were surveyed, 18% (N= 8) of which follow a sedation and analgesia protocol strictly, while 58% (N= 26) follow an "implied" protocol based on routine practice. The most commonly used drugs were midazolam, for sedation, and fentanyl, for analgesia. In 31% (N= 14) of the PICUs, sedation was monitored through assessment scales (modified Ramsay and/or Comfort scales). In 4% (N= 2) of units, daily, scheduled interruptions of sedation was implemented. In patients who are difficult to sedate, dexmedetomidine was the most commonly used adjuvant. In 73% (N= 33) of the units, neuromuscular blocking agents were used in compliance with precise guidelines and under clinical monitoring. In 20% (N= 9) of the PICUs there was a sedation and analgesia weaning protocol in place, and morphine and lorazepam are the most commonly used drugs. Conclusion. Only a low percentage of surveyed PICUs had a protocol in place for the routine management of sedation and analgesia in patients on MV.

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Additional use of methotrimeprazine for treating refractory agitation in pediatric patients

Cited by 17 publications

References 3 publications

Levomepromazine for difficult sedation in pediatric intensive care

Levomepromazine for difficult sedation in pediatric intensive care

Opioid false-positivity in urine drug screening: levomepromazine cross-reactivity

Sedation and analgesia in patients on mechanical ventilation in pediatric intensive care units in Argentina

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