Occurrence of withdrawal in critically ill sedated children

Fonsmark, Lise; Rasmussen, Yvonne H.; Carl, P

doi:10.1097/00003246-199901000-00052

Cited by 167 publications

(139 citation statements)

References 13 publications

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“…[38][39][40] Several withdrawal methods exist. In our setting, we have decreased drug therapy gradually down to 50% and then we give an equivalent medication orally in the same dose as continuous medication; six hours afterwards, we decrease the medication by 25%, and six hours after that, we withdraw the IV medication.…”

Section: Tolerance Dependence and Abstinencementioning

confidence: 99%

Analgesia e sedação em situações de emergência e unidades de tratamento intensivo pediátrico

Lago¹,

Piva²,

García³

et al. 2003

J. Pediatr. (Rio J.)

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Objective: To review the current strategies for use of sedatives and analgesics in emergency rooms and intensive care units. Sources of data:Original data from our emergency rooms and intensive care units; Medline literature review focused on sedatives and analgesic drugs; textbooks. Summary of the findings:Despite the advances in understanding pain in children, in many critical care units the misguided treatment of pain and anxiety still results in significant morbidity. Difficulties in communication, invasive procedures and the belief that children do not have sufficient neurologic development to process noxious sensations are still a challenge in intensive care units. Conclusions:The last decade was marked by significant advances in understanding pediatric pain. Treating intensive care unit-related pain and anxiety has clear benefits which may influence the course of disease.

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Section: Tolerance Dependence and Abstinencementioning

confidence: 99%

Analgesia e sedação em situações de emergência e unidades de tratamento intensivo pediátrico

Lago¹,

Piva²,

García³

et al. 2003

J. Pediatr. (Rio J.)

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“…The use of opiates and sedatives for more than five days often results in narcotic and benzodiazepine tolerance and dependence. [1][2][3][4] The management of withdrawal symptoms is a challenge frequently faced in the pediatric intensive care unit (PICU) setting. Few guidelines exist to treat or prevent withdrawal symptoms in pediatric patients.…”

Section: Introductionmentioning

confidence: 99%

Plasma Concentrations Following Application of Whole versus Cut Transdermal Clonidine Patches To Critically Ill Children

Zuppa

Tejani

Cullen

2004

The Journal of Pediatric Pharmacology and Therapeutics

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Clonidine is used for hypertension and narcotic withdrawal prophylaxis in adults and children. This study described plasma absorption of clonidine from whole and cut transdermal clonidine patches. This was a retrospective descriptive study in an 18 bed multidisciplinary pediatric intensive care unit, evaluating 15 critically ill children with a median age of 1.1 years (range 0.3-11 years) treated with transdermal clonidine for narcotic withdrawal prophylaxis, and who had plasma clonidine concentrations measured. An assessment of the relationship between clonidine dose and patch integrity (whole vs. cut) with plasma concentrations was performed, with further analysis by Spearman Correlation Coefficient. Clonidine doses averaged 7.5±4.2 µg/kg/day (range 2.3-20 µg/kg/day) for 9.8±4.3 days (range 4-20 days). There were 9 cut patches and 6 whole patches. The average prescribed dose delivered by cut patches was 6.4±3 µg/kg/day, resulting in a mean plasma concentration of 1±1.1 ng/ mL (range <0.05-3.3 ng/mL). The average prescribed dose delivered by whole patches was 7±1.7 µg/kg/day, resulting in a mean plasma concentration of 0.55±0.3 ng/mL (range 0.13-1.5 ng/mL). The Spearman Correlation Coefficient was calculated to evaluate the correlation between dose and concentration. For whole and cut patches the correlation coefficient was 0.94 (P=0.005) and 0.72 (P=0.002), respectively. Doses ranging from 1.7 to 20 µg/kg/day using whole patches resulted in no plasma concentrations >2 ng/mL. However, a plasma concentration >2 ng/mL was achieved with a dose of 8.8 µg/kg/day delivered by a cut patch. In addition, the 2 samples that resulted in undetectable concentrations were taken from patients who were treated with cut patches. The results from this pilot study suggest that critically ill children absorb clonidine from transdermal patches, but the rate and extent of absorption appears to be more predictable with the use of whole patches compared to patches that have been cut.

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“…Entre os mais comumente utilizados em UTIP, encontram-se os benzodiazepínicos (midazolan), os derivados da morfina (morfina e fentanil), os barbitúricos (tiopental) e a quetamina [1][2][3][4][5][6][7][8][9] .…”

Section: Introductionunclassified

“…De uma forma geral, estes agentes, com o uso contínuo e prolongado, induzem à tolerância, que é definida como a necessidade de doses maiores para obter o mesmo efeito sedativo ou analgésico [3][4][5] . Da mesma forma, pacientes expostos a terapias sedativas, opióides ou não, podem desenvolver neuroadaptação ou dependência fisiológica.…”

Section: Introductionunclassified

“…Da mesma forma, pacientes expostos a terapias sedativas, opióides ou não, podem desenvolver neuroadaptação ou dependência fisiológica. Assim, a suspensão rápida desses agentes pode causar sintomas de abstinência, que incluem dilatação de pupilas, sudorese, lacrimejamento, rinorréia, piloereção, taquicardia, vômitos, diarréia, hipertensão, febre, taquipnéia, agitação psicomotora e ansiedade [3][4][5]10 .…”

Section: Introductionunclassified

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Sedation and analgesia in children submitted to mechanical ventilation could be overestimated?

Fontela¹,

Moraes²,

Silva³

et al. 2003

J Pediatr (Rio J)

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Occurrence of withdrawal in critically ill sedated children

Cited by 167 publications

References 13 publications

Analgesia e sedação em situações de emergência e unidades de tratamento intensivo pediátrico

Analgesia e sedação em situações de emergência e unidades de tratamento intensivo pediátrico

Plasma Concentrations Following Application of Whole versus Cut Transdermal Clonidine Patches To Critically Ill Children

Sedation and analgesia in children submitted to mechanical ventilation could be overestimated?

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