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首页> 外文期刊>The Canadian journal of hospital pharmacy. >Use of Methadone for Prevention of Opioid Withdrawal in Critically III Children
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Use of Methadone for Prevention of Opioid Withdrawal in Critically III Children

机译：美沙酮在重症儿童中预防阿片类药物戒断的应用

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Background: Opioids are commonly administered to critically ill children for analgesia and sedation, but many patients experience opioid withdrawal upon discontinuation. The authors' institution developed a protocol for using methadone to prevent opioid withdrawal in children who have received morphine by continuous IV infusion for 5 days or longer in the pediatric intensive care unit (PICU). Objectives: The primary objectives were to determine if opioids were tapered according to the protocol and to determine the conversion ratio for IV morphine to oral methadone that was used. Secondary objectives were to describe the methadone dosage used and the clinical outcomes, to evaluate adjustments to methadone dosing, and to report the incidence of adverse effects.Methods: A retrospective analysis of charts was conducted for pediatric patients who had received morphine by continuous IV infusion for 5 days or longer followed by methadone in the PICU between May 2008 and August 2009. Validated scoring systems (the Withdrawal Assessment Tool and the State Behavioral Scale) were used to assess symptoms of withdrawal and degree of sedation, respectively. Results: Forty-three patients were included in the study, with median age of 8 months (range 0.25-201 months). For 31 patients (72%), the protocol was not used, and there were no patients for whom the protocol was followed to completion. The median duration of weaning was 10 days (range 0-91 days). The conversion ratio for IV morphine to oral methadone was 1:0.78 for anticipated 5-day weaning and 1:0.98 for anticipated 10-day weaning. During the first 10 days of weaning, 18 patients (42%) experienced withdrawal symptoms. The methadone dose was increased for 11 (26%) of the 43 patients. Patients were sedated for a median of 1 day (range 0-9 days), were comfortable for a median of 6.5 days (range 1-64 days), and were agitated for a median of 2.5 days (range 0-23 days). Naloxone was required for 2 patients. Conclusions: The institutions methadone protocol was not followed consistendy during the study period, and practices for transitioning from morphine by continuous IV infusion to methadone with tapering were also inconsistent. Further studies are needed to determine the optimal conversion ratio for morphine to methadone and the optimal tapering regimen to minimize withdrawal symptoms and adverse events.
机译：背景：阿片类药物通常用于重症儿童镇痛和镇静作用，但许多患者在停药后会出现阿片类药物停药。作者所在的机构制定了一种方案，用于在小儿重症监护病房（PICU）中连续5天或更长时间通过静脉输注接受吗啡的儿童，使用美沙酮预防阿片类药物戒断。目的：主要目的是确定阿片类药物是否按照方案渐缩，并确定静脉使用吗啡向口服美沙酮的转化率。次要目的是描述使用的美沙酮剂量和临床结局，评估对美沙酮剂量的调整并报告不良反应的发生率。方法：对通过连续静脉输注吗啡的儿科患者进行图表回顾性分析在2008年5月至2009年8月期间，在PICU中进行了5天或更长时间的治疗，其次是美沙酮。有效的评分系统（戒断评估工具和州行为量表）分别用于评估戒断症状和镇静程度。结果：43名患者被纳入研究，中位年龄为8个月（范围0.25-201个月）。对于31位患者（72％），未使用该方案，并且没有患者遵循该方案以完成治疗。断奶的中位时间为10天（范围为0-91天）。对于预期的5天断奶，IV吗啡向口服美沙酮的转化率为1：0.78，对于预期的10天断奶为1：0.98。在断奶的前10天中，有18名患者（42％）出现戒断症状。 43例患者中有11例（26％）增加了美沙酮剂量。给患者镇静1天（0-9天），感到舒适6.5天（1-64天），并且激动2.5天（0-23天）。 2名患者需要纳洛酮。结论：研究期间未遵循机构的美沙酮治疗方案，连续静脉输注从吗啡向逐渐减量的美沙酮过渡的做法也不一致。需要进一步的研究来确定吗啡向美沙酮的最佳转化率和最佳的减量方案，以最大程度地减少戒断症状和不良事件。

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