Out-patient Therapy of Iatrogenic Opioid Dependency following Prolonged Sedation in the Pediatric Intensive Care Unit

As a result of heightened awareness of the need for aggressive sedation and analgesia in the pediatric intensive care unit population, the risk for opioid withdrawal continues to increase. Although gradual tapering of the intravenous dose of opioid can be used to prevent such problems, this approach mandates maintenance of intravenous access and in-patient hospital admission. I present experience with the out-patient use of oral methadone to prevent opioid withdrawal following prolonged fentanyl sedation in the pediatric intensive care unit. A cohort of 18 patients is reviewed, and suggested guidelines for out-patient management of these patients using oral methadone are presented.