title: Subcutaneous administration of fentanyl and midazolam to prevent withdrawal after prolonged sedation in children.
abstract: OBJECTIVE
  To determine the efficacy of switching to subcutaneous fentanyl with or without midazolam to prevent withdrawal after prolonged sedation in children in the pediatric intensive care unit (PICU).
  
  
  METHODS
  Retrospective review of hospital records.
  
  
  METHODS
  Tertiary care center, PICU.
  
  
  METHODS
  The cohort for the study included patients who had received subcutaneous fentanyl with or without midazolam to prevent withdrawal after prolonged sedation in the PICU.
  
  
  RESULTS
  Subcutaneous fentanyl with or without midazolam was administered to nine patients ranging in age from 3 to 7 yrs (mean, 4.4 +/- 1.8 yrs) and ranging in weight from 11 to 31 kg (mean, 20.1 +/- 6.8 kg). All patients required prolonged administration of fentanyl with or without midazolam during mechanical ventilation for respiratory failure. The starting infusion rate for subcutaneous fentanyl varied from 5 to 9 microg/kg/hr (mean, 7.1 +/- 1.4 microg/kg/hr). Four patients also received subcutaneous midazolam at a rate of 0.15 to 0.3 mg/kg/hr (mean, 0.24 mg/kg/hr). Subcutaneous access was maintained for 3-7 days (mean, 5.7 +/- 1.4 days) in the nine patients. No problems with the subcutaneous access were noted during treatment. The fentanyl infusion was decreased by 1 microg/kg/hr every 12-24 hrs and the midazolam infusion was decreased by 0.05 mg/kg/hr every 12-24 hrs. No patient demonstrated signs of symptoms of moderate to severe withdrawal.
  
  
  CONCLUSIONS
  The subcutaneous route provides an effective alternative to intravenous administration. It allows for gradual weaning from sedative/analgesic agents after prolonged sedation while eliminating the need to maintain intravenous access.
authors.affiliation: Department of Child Health, University of Missouri, Columbia 65212, USA. joseph_tobias@muccmail.missouri.edu
authors.forename: J D
authors.initials: JD
authors.lastname: Tobias
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage*; D001835:Body Weight; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation; D005283:Fentanyl / Q000008:administration & dosage*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007279:Injections, Subcutaneous; D015278:Intensive Care Units, Pediatric; D008874:Midazolam / Q000008:administration & dosage*; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000628:therapy; D012189:Retrospective Studies; D013375:Substance Withdrawal Syndrome / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D008874:Midazolam; D005283:Fentanyl