Occurrence of withdrawal in critically ill sedated children.

OBJECTIVES To record the number of children with withdrawal symptoms after the administration of sedatives for mechanical ventilation, and to discuss the possible connection with the administration of midazolam. DESIGN Retrospective data collection from case records and charts. SETTING Medical and surgical intensive care unit (ICU) in a university hospital. PATIENTS Children 6 months to 14 yrs of age who required sedation for mechanical ventilation (n = 40). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Kind and amount of sedatives and analgesics, duration of administration, and occurrence of withdrawal symptoms. The frequency of withdrawal symptoms was 35% (14/40) of the sedated children. A total dose of midazolam of >60 mg/kg was strongly significantly associated with occurrence of withdrawal. Statistical analysis to determine the occurrence of withdrawal associated with the administration of morphine was not possible. CONCLUSIONS Signs and symptoms of a withdrawal reaction were observed in several children. The occurrence of withdrawal was statistically related to high doses of midazolam, but it was not possible to determine the influence of morphine. If large doses of midazolam and opioids have been administered, there may be justification for reducing the dose gradually instead of abruptly, or using longer-acting benzodiazepines or opioids on discontinuation of sedation.

[1]  M. Ducharme,et al.  Severe Withdrawal Syndrome Possibly Associated With Cessation of a Midazolam and Fentanyl Infusion , 1995, Pharmacotherapy.

[2]  H. Kelly,et al.  Prospective study on the occurrence of withdrawal in critically ill children who receive fentanyl by continuous infusion , 1994, Critical care medicine.

[3]  J. Blumer,et al.  Pediatric intensive care sedation: survey of fellowship training programs. , 1993, Pediatrics.

[4]  G. Burckart,et al.  Reversible neurologic abnormalities associated with prolonged intravenous midazolam and fentanyl administration. , 1991, The Journal of pediatrics.

[5]  D. Linton,et al.  Midazolam‐induced benzodiazepine withdrawal syndrome , 1991, Anaesthesia.

[6]  E. Orav,et al.  Tolerance and dependence in neonates sedated with fentanyl during extracorporeal membrane oxygenation. , 1990, Anesthesiology.

[7]  M. Sury,et al.  Acute benzodiazepine withdrawal syndrome after midazolam infusions in children. , 1989, Critical care medicine.

[8]  D. Rosen,et al.  Continuous intravenous midazolam infusion for sedation in the pediatric intensive care unit. , 1988, Anesthesia and analgesia.

[9]  C. Naranjo,et al.  Withdrawal reaction after long-term therapeutic use of benzodiazepines. , 1986, The New England journal of medicine.

[10]  A. Lloyd-Thomas,et al.  Sedation of children requiring artificial ventilation using an infusion of midazolam. , 1986, British journal of anaesthesia.

[11]  A. Lloyd-Thomas,et al.  Infusion of midazolam in paediatric patients after cardiac surgery. , 1986, British journal of anaesthesia.

[12]  J G Reves,et al.  Midazolam: Pharmacology and Uses , 1985, Anesthesiology.

[13]  W. Parker,et al.  Benzodiazepine withdrawal syndrome: a literature review and evaluation. , 1982, The American journal of drug and alcohol abuse.