title: Use of fentanyl and midazolam in mechanically ventilated children--Does the method of infusion matter?
abstract: OBJECTIVE
  Benzodiazepines and opioids are commonly used in pediatric intensive care unit. However, there is no previous study assessing the use of administering these drugs combined (single solution) or separately. We sought to evaluate the impact of these 2 different methods of providing sedation/analgesia in pediatric intensive care unit.
  
  
  METHODS
  One hundred twelve patients mechanically ventilated for more than 48 hours were randomized to receive a protocolized sedation regime comprising midazolam and fentanyl either separately (group 1, 57 patients) or combined as a single solution (group 2, 55 patients). Primary end point variable was the cumulated dose of midazolam and fentanyl.
  
  
  RESULTS
  The median cumulated doses of both fentanyl (0.19 vs 0.37 mg/kg, P < .05) and midazolam (28.8 vs 45.6 mg/kg, P < .05) required in group 2 were higher when compared with those of group 1. Moreover, group 2 patients had a significantly longer time of vasopressor drugs requirement and a higher number of patients developing tolerance.
  
  
  CONCLUSIONS
  Patients who received a single solution of midazolam and fentanyl had a higher cumulated dose of compared with those patients who did not. The potential risk for long-term neurologic effects on developing brains associated with this finding should be considered.
authors.affiliation: Pediatric Intensive Care Unit, Department of Pediatrics, Hospital do Servidor Público Municipal, São Paulo, Brazil. Electronic address: psls.nat@terra.com.br.
authors.forename: Paulo Sérgio Lucas
authors.initials: PS
authors.lastname: da Silva
authors.affiliation: Hospital e Maternidade Santa Joana, São Paulo, Brazil. Electronic address: eunice.resi@terra.com.br.
authors.forename: Maria Eunice
authors.initials: ME
authors.lastname: Reis
authors.affiliation: Pediatric Intensive Care Unit, Department of Pediatrics, Hospital do Servidor Público Municipal, São Paulo, Brazil. Electronic address: vea@uol.com.br.
authors.forename: Vânia Euzébio
authors.initials: VE
authors.lastname: de Aguiar
authors.affiliation: Health Technology Assessment Unit, Federal University of São Paulo (UNIFESP), São Paulo, Brazil. Electronic address: marcelo.fonseca@axia.bio.br.
authors.forename: Marcelo Cunio Machado
authors.initials: MC
authors.lastname: Fonseca
mesh_terms: D000293:Adolescent; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D001569:Benzodiazepines / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000379:methods; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007262:Infusions, Intravenous; D015278:Intensive Care Units, Pediatric; D008297:Male; D008874:Midazolam / Q000008:administration & dosage*; D012121:Respiration, Artificial / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome; D012122:Ventilators, Mechanical
chemical_list: D000701:Analgesics, Opioid; D004338:Drug Combinations; D006993:Hypnotics and Sedatives; D001569:Benzodiazepines; D008874:Midazolam; D005283:Fentanyl
keywords: Benzodiazepine; Fentanyl; Midazolam; Opiate; Pediatric intensive care; Sedation