Article Text

OPIOID AND BENZODIAZEPINE WITHDRAWAL PROTOCOL IN PEDIATRIC CARDIAC INTENSIVE CARE UNIT (PCICU)
  1. Y Gendler1,
  2. M Keller1,
  3. O Manor-Shulman1,
  4. I Ronen2,
  5. R Efrat2,
  6. O Dagan1
  1. 1Pediatric Cardiac Intensive Care Unit, Schneider Children’s Medical Center of Israel, Petach-Tikva, Israel
  2. 2Pain Management Unit, Schneider Children’s Medical Center of Israel, Petach-Tikva, Israel

Abstract

Background Prolonged administration of opioids and benzodiazepines in children in the PCICU may induce physiological dependence and withdrawal symptoms. In our unit, we use oral oxycodone and diazepam for the weaning process, with gradual decrease in dosing. Sedation withdrawal score (SWS) was used to determine withdrawal symptoms in infants and children after heart surgery, who received opioids and benzodiazepine for prolonged duration. The scoring was done every shift by the nursing staff and guided the rate of reduction.

Objective To increase the awareness of the nursing staff to the possibility of withdrawal symptoms among patients who receive analgesia for long period of time. To determine a policy for identification, management and treatment of withdrawal syndrome.

Methods A written “withdrawal protocol” was used on patients who received analgesia and sedation for more than 5 days. Patients were assessed for signs of withdrawal every 8 hours using the SWS. Further advance with the weaning process was done according to the score and symptoms.

Findings Since January 1 2008, 18 children (2 weeks–18 months of age), who underwent cardiac surgery, were treated according to the “withdrawal protocol”. Six children showed severe to moderate withdrawal symptoms. Clinically significant symptoms developed on average of 3 days after the commencement of the weaning-process. The nursing staff compliance to filling in the SWS was 70%.

Conclusion Further use of “withdrawal protocol” will improve the treatment of patients who suffer from withdrawal symptoms. Still, more research is needed to establish the optimal methods for prevention and management of withdrawal in PCICU.

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