Uso de metadona para el destete de sedación en paciente pediátrico
DOI:
https://doi.org/10.30445/rear.v11i4.743Palabras clave:
opioides, dosis reducidas, destete, retirada, abstinencia, pediatría, críticos, sedaciónResumen
Los opioides usados durante más de cinco días, para sedación en paciente pediátrico, deben ser retirado de forma progresiva con el objetivo de prevenir abstinencia. Para este propósito las pautas de retirada con metadona enteral son frecuentemente utilizadas. Sin embargo, la dificultad en la apliación de protocolos y la diferencia entre pacientes, hacen que esta práctica no esté exenta de dificultad.
En este artículo intentamos dar respuesta o al menos sugerir pautas, para realizar esta práctica.
Citas
- Giby K, Vaillancourt R, Varughese N, Vadeboncoeur C, Pouliot A. Use of Methadone for Opioid Weaning in Children: Prescribing Practices and Trends. Can J Hosp Pharm. 2014 Mar-Apr; 67(2): 149–156
- Fife A, Postier A, Flood A, Friedrichsdorf SJ. Methadone conversion in infants and children: Retrospective cohort study of 199 pediatric inpatients. J Opioid Manag. 2016 May-Jun;12(2):123-30.
- Srinivasan V, Pung P, O’Neill SP. Conversion from prolonged intravenous fentanyl infusion to enteral methadone in critically ill children. World J Clin Pediatr. 2017 May 8; 6(2): 110–117
- Bowens CD, Thompson JA, Thompson MT, Breitzka RL, Thompson DG, Sheeran PW. A trial of methadone tapering schedules in pediatric intensive care unit patients exposed to prolonged sedative infusions. Pediatr Crit Care Med. 2011 Sep;12(5):504-11.
- Dervan LA, Yaghmai B, Watson RS, Wolf FM The use of methadone to facilitate opioid weaning in pediatric critical care patients: a systematic review of the literature and meta-analysis. Paediatr Anaesth. 2017 Mar;27(3):228-239.
- Abdouni R, Reyburn-Orne T, Youssef TH, Haddad IY, Gerkin RD J. Impact of a Standardized Treatment Guideline for Pediatric Iatrogenic Opioid Dependence: A Quality Improvement Initiative. Pediatr Pharmacol Ther. 2016 Jan-Feb; 21(1):54-65.
- Anand KJ, Willson DF, Berger J, et al., Tolerance and withdrawal from prolonged opioid use in critically ill children. Pediatrics. 2010;125(5).
- Katz R, Kelly HW, Hsi A Prospective study on the occurrence of withdrawal in critically ill children who receive fentanyl by continuous infusion. Crit Care Med. 1994 May; 22(5):763-7
- Jeffries S, McGloin R, Pitfield A, Carr R. Use of Methadone for Prevention of Opioid Withdrawal in Critically Ill Children children. Can J Hosp Pharm. 2012 Jan-Feb; 65(1): 12–18.
- Iyer Devasena; Schooler, Kevi. Wat-1 vs SOS a comparison of tools to measure sedation withdrawal in the ICU. Critical Care Medicine: December 2013 doi: 10.1097/01.
- Basker S, Singh G, Jacob R Clonidine In Paediatrics - A Review. Indian J Anaesth. 2009 Jun; 53(3): 270–280.
- Fernández F, Gabolia M, González R, Gómez de Quero-Masía P, Fernández S, Murga V, Serrano O, Sánchez J.M, Payo R. Withdrawal syndrome in the pediatric intensive care unit. Incidence and risk factors. Med Intensiva 2013;37:67-74 - Vol. 37 Num.2
- 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(6):2122–2132.
- Robertson RC1, Darsey E, Fortenberry JD, Pettignano R, Hartley G. Evaluation of an opiate-weaning protocol using methadone in pediatric intensive care unit patients. Pediatr Crit Care Med. 2000 Oct;1(2):119-23.
- Lugo RA, Satterfield KL, Kern SE. Pharmacokinetics of methadone. J Pain Palliat Care Pharmacother.2005;19(4):13–24.
- Steineck KJ1, Skoglund AK, Carlson MK, Gupta S. Evaluation of a pharmacist-managed methadone taper*. Pediatr Crit Care Med. 2014 Mar;15(3):206-10.
Lecturas y protocolos recomendados:
- https://www.starship.org.nz/for-health-professionals/starship-clinical-guidelines/w/weaning-of-opioids-and-benzodiazepines/
https://www.eastbaynewborn.com/docs/Treatment%20of%20Iatrogenic%20Opiate%20Withdrawal%20in%20the%20NICU%20(2).pdf
https://download.lww.com/wolterskluwer_vitalstream_com/PermaLink/PCC/A/PCC_15_3_2013_10_28_STEINECK_13-00084_SDC1.pdf
- Fife A, Postier A, Flood A, Friedrichsdorf SJ. Methadone conversion in infants and children: Retrospective cohort study of 199 pediatric inpatients. J Opioid Manag. 2016 May-Jun;12(2):123-30.
- Srinivasan V, Pung P, O’Neill SP. Conversion from prolonged intravenous fentanyl infusion to enteral methadone in critically ill children. World J Clin Pediatr. 2017 May 8; 6(2): 110–117
- Bowens CD, Thompson JA, Thompson MT, Breitzka RL, Thompson DG, Sheeran PW. A trial of methadone tapering schedules in pediatric intensive care unit patients exposed to prolonged sedative infusions. Pediatr Crit Care Med. 2011 Sep;12(5):504-11.
- Dervan LA, Yaghmai B, Watson RS, Wolf FM The use of methadone to facilitate opioid weaning in pediatric critical care patients: a systematic review of the literature and meta-analysis. Paediatr Anaesth. 2017 Mar;27(3):228-239.
- Abdouni R, Reyburn-Orne T, Youssef TH, Haddad IY, Gerkin RD J. Impact of a Standardized Treatment Guideline for Pediatric Iatrogenic Opioid Dependence: A Quality Improvement Initiative. Pediatr Pharmacol Ther. 2016 Jan-Feb; 21(1):54-65.
- Anand KJ, Willson DF, Berger J, et al., Tolerance and withdrawal from prolonged opioid use in critically ill children. Pediatrics. 2010;125(5).
- Katz R, Kelly HW, Hsi A Prospective study on the occurrence of withdrawal in critically ill children who receive fentanyl by continuous infusion. Crit Care Med. 1994 May; 22(5):763-7
- Jeffries S, McGloin R, Pitfield A, Carr R. Use of Methadone for Prevention of Opioid Withdrawal in Critically Ill Children children. Can J Hosp Pharm. 2012 Jan-Feb; 65(1): 12–18.
- Iyer Devasena; Schooler, Kevi. Wat-1 vs SOS a comparison of tools to measure sedation withdrawal in the ICU. Critical Care Medicine: December 2013 doi: 10.1097/01.
- Basker S, Singh G, Jacob R Clonidine In Paediatrics - A Review. Indian J Anaesth. 2009 Jun; 53(3): 270–280.
- Fernández F, Gabolia M, González R, Gómez de Quero-Masía P, Fernández S, Murga V, Serrano O, Sánchez J.M, Payo R. Withdrawal syndrome in the pediatric intensive care unit. Incidence and risk factors. Med Intensiva 2013;37:67-74 - Vol. 37 Num.2
- 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(6):2122–2132.
- Robertson RC1, Darsey E, Fortenberry JD, Pettignano R, Hartley G. Evaluation of an opiate-weaning protocol using methadone in pediatric intensive care unit patients. Pediatr Crit Care Med. 2000 Oct;1(2):119-23.
- Lugo RA, Satterfield KL, Kern SE. Pharmacokinetics of methadone. J Pain Palliat Care Pharmacother.2005;19(4):13–24.
- Steineck KJ1, Skoglund AK, Carlson MK, Gupta S. Evaluation of a pharmacist-managed methadone taper*. Pediatr Crit Care Med. 2014 Mar;15(3):206-10.
Lecturas y protocolos recomendados:
- https://www.starship.org.nz/for-health-professionals/starship-clinical-guidelines/w/weaning-of-opioids-and-benzodiazepines/
https://www.eastbaynewborn.com/docs/Treatment%20of%20Iatrogenic%20Opiate%20Withdrawal%20in%20the%20NICU%20(2).pdf
https://download.lww.com/wolterskluwer_vitalstream_com/PermaLink/PCC/A/PCC_15_3_2013_10_28_STEINECK_13-00084_SDC1.pdf
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Publicado
2020-09-10
Cómo citar
Ferreras Vega, R., Ruiz Escobar, A., Romero Layos, M., & Méndez Marín, M. D. (2020). Uso de metadona para el destete de sedación en paciente pediátrico. Revista Electrónica AnestesiaR, 11(4), 1. https://doi.org/10.30445/rear.v11i4.743
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