Dexmedetomidine to treat opioid withdrawal in infants following prolonged sedation in the pediatric ICU

Authors

  • Joseph D. Tobias, MD

DOI:

https://doi.org/10.5055/jom.2006.0031

Keywords:

dexmedetomidine, pediatric, opioid, opioid withdrawal

Abstract

This retrospective study aims to report on the use of dexmedetomidine to treat opioid withdrawal following sedation during mechanical ventilation in a cohort of infants. Seven infants in the pediatric intensive care unit of a tertiary care center, ranging in age from three to 24 months (12.4 ± 8.2 months) and in weight from 4.6 to 15.4 kgs (9.9 ± 4.2 kgs), had received a continuous fentanyl infusion, supplemented with intermittent doses of midazolam for sedation, during mechanical ventilation. Withdrawal was documented by a Finnegan score ³ 12. Dexmedetomidine was administered as a loading dose of 0.5 mg/kg/hr, followed by an infusion of 0.5 mg/kg/hr.
Dexmedetomidine effectively controlled the signs and symptoms of withdrawal in the seven patients. Subsequent Finnegan scores were £ 7 at all times (median 4, range 1 to 7). Two patients required a repeat of the loading dose and an increase of the infusion to 0.7 mg/kg/hr. These two patients had received higher doses of fentanyl than the other five patients (8.5 ± 0.7 versus 4.6 ± 0.5 mg/kg/hr, p < 0.0005). No adverse hemodynamic or respiratory effects related to dexmedetomidine were noted.
This report involves the largest cohort of patients to receive dexmedetomidine in the treatment of withdrawal following opioid and benzodiazepine sedation during mechanical ventilation. We conclude that dexmedetomidine offers a viable option for such issues in the pediatric intensive care unit (PICU) setting.

Author Biography

Joseph D. Tobias, MD

Departments of Anesthesiology and Pediatrics, University of Missouri, Columbia, Missouri.

References

Tobias JD: Tolerance, withdrawal, and physical dependency after long-term sedation and analgesia of children in the pediatric intensive care unit. Crit Care Med. 2000; 28: 2122-2132.

Tobias JD: Subcutaneous administration of fentanyl and midazolam to prevent withdrawal after prolonged sedation in children. Crit Care Med. 1999; 27: 2262-2265.

Maccioli GA: Dexmedetomidine to facilitate drug withdrawal. Anesthesiology. 2003; 98: 575-577.

Multz AS: Prolonged dexmedetomidine infusion as an adjunct in treating sedation-induced withdrawal. Anesth Analg. 2003; 96: 1054-1055.

Finkel JC, Elrefai A: The use of dexmedetomidine to facilitate opioid and benzodiazepine detoxification in an infant. Anesth Analg. 2004; 98: 1658-1659.

Baddigam K, Russo P, Russo J, et al.: Dexmedetomidine in the treatment of withdrawal syndromes in cardiothoracic surgery patients. J Intensive Care Med. 2005; 20: 118-123.

Finnegan LP: Effects of maternal opiate abuse on the newborn. Fed Proc. 1985; 44: 2314-2317.

Finnegan LP, Connaughton JF Jr, Kron RE, et al.: Neonatal abstinence syndrome: Assessment and management. Addict Dis. 1975; 1: 141-158.

Baumgartner GR, Rowen RC: Transdermal clonidine versus chlorodiazepoxide in alcohol withdrawal: A randomized, controlled clinical trial. South Med J. 1991; 84: 312-321.

Dobrydnjov I, Axelsson K, Berggren L, et al.: Intrathecal and oral clonidine as prophylaxis for postoperative alcohol withdrawal syndrome: A randomized double-blinded study. Anesth Analg. 2004; 98: 738-744.

Lichtman AH, Fisher J, Martin BR: Precipitated cannabinoid withdrawal is reversed by. 9-tetrahydrocannabinoid or clonidine. Pharm Biochem Behav. 2001; 69: 181-188.

Yam PCI, Forbes A, Kox WJ: Clonidine in the treatment of alcohol withdrawal in the intensive care unit. Br J Anaesth. 1992; 68: 106-108.

Hoder EL, Leckman JF, Ehrenkranz R, et al.: Clonidine in neonatal narcotic-abstinence syndrome. N Engl J Med. 1981; 305: 1284-1285.

Ashton H: Benzodiazepine withdrawal: Outcome in 50 patients. Br J Addict. 1987; 82: 665-671.

American Academy of Pediatrics Committee on Drugs: Neonatal drug withdrawal. Pediatrics. 1998; 6: 113-117.

McClain BC, Porbst LA, Pinter E, et al.: Intravenous clonidine use in a neonatal experiencing opioid-induced myoclonus. Anesthesiology. 2001; 95: 549-550.

Riihioja P, Jaatinen P, Oksanen H, et al.: Dexmedetomidine, diazepam, and propranolol in the treatment of alcohol withdrawal symptoms in the rat. Alcohol Clin Exp Res. 1997; 21: 804-808.

Riihioja P, Jaatinen P, Haapalinna, et al.: Effects of dexmedetomidine on rat loceus coeruleus and ethanol withdrawal symptoms during intermittent ethanol exposure. Alcohol Clin Exp Res. 1999; 23: 432-438.

Riihioja P, Jaatinen P, Oksanen H, et al.: Dexmedetomidine alleviates ethanol withdrawal symptoms in the rat. Alcohol. 1997; 14: 537-544.

Riihioja P, Jaatinen P, Haapalinna, et al.: Prevention of ethanol-induced sympathetic overactivity and degeneration by dexmedetomidine. Alcohol. 1995; 12: 439-446.

Finkel JC, Johnson YJ, Quezado YMN: The use of dexmedetomidine to facilitate acute discontinuation of opioids alter cardiac transplantation in children. Crit Care Med. 2005; 33: 2110-2112.

Belleville JP, Ward DS, Bloor BC, et al.: Effects of intravenous dexmedetomidine in humans. Anesthesiology. 1992; 77: 1125-1133.

Talke P, Chen R, Thomas B, et al.: The hemodynamic and adrenergic effects of perioperative dexmedetomidine infusion after vascular surgery. Anesth Analg. 2000; 90: 834-839.

Peden CJ, Cloote AH, Stratford N, et al.: The effect of intravenous dexmedetomidine premedication on the dose requirement of propofol to induce loss of consciousness in patients receiving alfentanil. Anaesthesia. 201; 56: 408-413.

Berkenbosch JW, Tobias JD: Development of bradycardia during sedation with dexmedetomidine in an infant concurrently receiving digoxin. Pediatr Crit Care Med. 2003; 4: 203-205.

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Published

07/01/2006

How to Cite

Tobias, MD, J. D. “Dexmedetomidine to Treat Opioid Withdrawal in Infants Following Prolonged Sedation in the Pediatric ICU”. Journal of Opioid Management, vol. 2, no. 4, July 2006, pp. 201-5, doi:10.5055/jom.2006.0031.

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Section

Case Studies