Minimizing tolerance and withdrawal to prolonged pediatric sedation: case report and review of the literature.
Minimizing tolerance and withdrawal to prolonged pediatric sedation: case report and review of the literature.
复制标题
DOI：
10.1177/0885066607299556
复制
发表时间：
2007-05-01
影响因子：
3.1
通讯作者：
Inchiosa, Mario A Jr
中科院分区：
文献类型：
--
作者：
Cho, Hannah H;O'Connell, James P;Inchiosa, Mario A Jr
咪达唑仑和芬太尼输注通常用于儿科重症监护室的长期镇静和镇痛。当这些输注使用数天或数周时，耐受性和戒断是主要问题。在这里，我们回顾了目前使用咪达唑仑和芬太尼长期小儿镇静的方法，并讨论了避免耐受和戒断综合征的新策略。我们报告了我们机构一名出现耐受综合征和运动障碍的儿童烧伤患者的病例。我们还回顾了最小化耐受性和戒断性的相关文献和方法。治疗危重儿童通常需要长时间镇静，而耐受和戒断综合征可能会使康复过程复杂化。评分系统可用于最大程度地减少过度镇静并有效进行滴定。 “药物循环”、“唤醒方案”和断奶方案（可能与辅助药物相结合）正在成功实施。这种新方法可能会降低与长期使用镇静剂和镇痛剂相关的耐受性和戒断的发生率。
Midazolam and fentanyl infusions are commonly used for prolonged sedation and analgesia in the pediatric intensive care setting. Tolerance and withdrawal are major concerns when these infusions are used for days or weeks. Here, we review the current approaches to prolonged pediatric sedation using midazolam and fentanyl and discuss newer strategies to avoid tolerance and withdrawal syndromes. We report the case of a pediatric burn patient who developed tolerance syndrome and a movement disorder in our institution. We also review the relevant literature and methods of minimizing tolerance and withdrawal. Prolonged sedation is often necessary in treating critically ill children, and tolerance and abstinence syndrome can complicate a successful recovery. Scoring systems can be used to minimize oversedation and to titrate effectively. "Drug cycling," "wake-up protocols," and weaning regimens, possibly combined with adjuvant drugs, are being implemented successfully. Such novel approaches may decrease the incidence of tolerance and withdrawal associated with prolonged sedative and analgesic use.