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Tolerance and withdrawal from prolonged opioid use in critically ill children.
- Source :
-
Pediatrics [Pediatrics] 2010 May; Vol. 125 (5), pp. e1208-25. Date of Electronic Publication: 2010 Apr 19. - Publication Year :
- 2010
-
Abstract
- Objective: After prolonged opioid exposure, children develop opioid-induced hyperalgesia, tolerance, and withdrawal. Strategies for prevention and management should be based on the mechanisms of opioid tolerance and withdrawal.<br />Patients and Methods: Relevant manuscripts published in the English language were searched in Medline by using search terms "opioid," "opiate," "sedation," "analgesia," "child," "infant-newborn," "tolerance," "dependency," "withdrawal," "analgesic," "receptor," and "individual opioid drugs." Clinical and preclinical studies were reviewed for data synthesis.<br />Results: Mechanisms of opioid-induced hyperalgesia and tolerance suggest important drug- and patient-related risk factors that lead to tolerance and withdrawal. Opioid tolerance occurs earlier in the younger age groups, develops commonly during critical illness, and results more frequently from prolonged intravenous infusions of short-acting opioids. Treatment options include slowly tapering opioid doses, switching to longer-acting opioids, or specifically treating the symptoms of opioid withdrawal. Novel therapies may also include blocking the mechanisms of opioid tolerance, which would enhance the safety and effectiveness of opioid analgesia.<br />Conclusions: Opioid tolerance and withdrawal occur frequently in critically ill children. Novel insights into opioid receptor physiology and cellular biochemical changes will inform scientific approaches for the use of opioid analgesia and the prevention of opioid tolerance and withdrawal.
- Subjects :
- Analgesics, Opioid administration & dosage
Brain drug effects
Child
Child, Preschool
Drug Tolerance
Humans
Infant
Infant, Newborn
Neurons drug effects
Opioid-Related Disorders prevention & control
Receptors, Opioid drug effects
Substance Withdrawal Syndrome prevention & control
Tachyphylaxis
Analgesics, Opioid adverse effects
Critical Illness
Opioid-Related Disorders rehabilitation
Pain drug therapy
Substance Withdrawal Syndrome diagnosis
Subjects
Details
- Language :
- English
- ISSN :
- 1098-4275
- Volume :
- 125
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Pediatrics
- Publication Type :
- Academic Journal
- Accession number :
- 20403936
- Full Text :
- https://doi.org/10.1542/peds.2009-0489