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Opioid tapering and weaning protocols in pediatric critical care units: a systematic review.
Bichaff, Pedro; Setani, Karina T; Motta, Emiliana H G; Delgado, Artur F; Carvalho, Werther B; Luglio, Michele.
Afiliação
  • Bichaff P; Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da USP, São Paulo (SP), Brasil.
  • Setani KT; Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da USP, São Paulo (SP), Brasil.
  • Motta EHG; Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da USP, São Paulo (SP), Brasil.
  • Delgado AF; Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da USP, São Paulo (SP), Brasil.
  • Carvalho WB; Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da USP, São Paulo (SP), Brasil.
  • Luglio M; Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da USP, São Paulo (SP), Brasil.
Rev Assoc Med Bras (1992) ; 64(10): 909-915, 2018 Oct.
Article em En | MEDLINE | ID: mdl-30517238
OBJECTIVE: Opioid abstinence syndrome is common in the pediatric intensive care environment because sedation is often needed during the children's treatment. There is no specific guideline regarding the management of these patients; and lately, methadone is an important drug for the prevention of abstinence symptoms during the weaning of opioids. This study gathers the available research to establish the initial dose of methadone, the rate of taper and tools to recognize this syndrome and act promptly. METHODS: A systematic review was made from data of four different databases. Forty-nine articles of observational and experimental studies were selected based on the inclusion criteria (critical pediatric patients in acute use of opioids) and exclusion criteria (previous chronic use of opioids, other medications). The data regarding specific themes were separated in sections: initial dose of methadone, use of protocols in clinical practice, abstinence scales and adjuvant drugs. RESULTS: The articles showed a great heterogeneity of ways to calculate the initial dose of methadone. The pediatric intensive care units of the study had different weaning protocols, with a lower incidence of abstinence when a pre-defined sequence of tapering was used. The Withdrawal Assessment Tool - 1 was the most used scale for tapering the opioids, with good sensitivity and specificity for signs and symptoms. CONCLUSION: There is still little evidence of other medications that can help prevent the abstinence syndrome of opioids. This study tries to promote a better practice during opioid weaning.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Síndrome de Abstinência a Substâncias / Analgésicos Opioides / Metadona Tipo de estudo: Guideline / Systematic_reviews Limite: Child / Humans Idioma: En Revista: Rev Assoc Med Bras (1992) Ano de publicação: 2018 Tipo de documento: Article País de afiliação: Brasil País de publicação: Brasil

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Síndrome de Abstinência a Substâncias / Analgésicos Opioides / Metadona Tipo de estudo: Guideline / Systematic_reviews Limite: Child / Humans Idioma: En Revista: Rev Assoc Med Bras (1992) Ano de publicação: 2018 Tipo de documento: Article País de afiliação: Brasil País de publicação: Brasil