title: Outpatient therapy of iatrogenic drug dependency following prolonged sedation in the pediatric intensive care unit.
abstract: The authors present their clinical experience with the oral administration of lorazepam, methadone, and pentobarbital to prevent or treat withdrawal symptoms following prolonged sedation in the PICU patient. The 3 patients presented required prolonged sedation for mechanical ventilation. Different agents were used for sedation in the 3 patients including intravenous fentanyl, midazolam, and pentobarbital. The switch to oral agents must take into consideration the differences in potency, half-life, and oral bioavailability between the agents. The authors discuss the appropriate conversion factors for opioids, benzodiazepines, and barbiturates. The switch to oral administration eliminated the need for intravenous access in the 3 patients and allowed for earlier discharge home. All 3 patients were discharged home on an oral, taper schedule. Such an approach may lead to earlier home discharge thereby improving the patient's quality of life as well as saving health care dollars.
authors.affiliation: Department of Pediatrics, Vanderbilt University, Nashville, Tennessee 37232.
authors.forename: J D
authors.initials: JD
authors.lastname: Tobias
authors.forename: J K
authors.initials: JK
authors.lastname: Deshpande
authors.forename: D F
authors.initials: DF
authors.lastname: Gregory
mesh_terms: D002648:Child; D005260:Female; D005283:Fentanyl; D006801:Humans; D007049:Iatrogenic Disease; D007223:Infant; D008140:Lorazepam / Q000008:administration & dosage; D008297:Male; D008691:Methadone / Q000008:administration & dosage; D008874:Midazolam; D010634:Phenobarbital / Q000008:administration & dosage; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy*; D019966:Substance-Related Disorders / Q000188:drug therapy*
chemical_list: D008140:Lorazepam; D008874:Midazolam; D008691:Methadone; D005283:Fentanyl; D010634:Phenobarbital