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Efficacy of an enteral 10-day methadone wean to prevent opioid withdrawal in fentanyl-tolerant pediatric intensive care unit patients

Meyer, Michael T. Major, MD; Berens, Richard J. MD

Pediatric Critical Care Medicine:
Clinical Investigations
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 μg/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.

Author Information

From the Air Force Institute of Technology, Wright-Patterson Air Force Base, Dayton, Ohio (Dr. Meyer); and the Departments of Pediatrics (Drs. Meyer and Berens) and Anesthesiology (Dr. Berens), Medical College of Wisconsin, Milwaukee, Wisconsin.

The views expressed in this article are those of the author and do not reflect the official policy or position of the United States Air Force, Department of Defense, or the U.S. Government.

Address requests for reprints to: Major Michael T. Meyer, MD, San Antonio Military Pediatric Center, Wilford Hall Medical Center/MMNP, 2000 Bergquist Drive, Suite 1, Lackland AFB TX, 78236-5300. E-mail:michael.meyer@59mdw.whmc.af.mil

© 2001 Lippincott Williams & Wilkins, Inc.