Department of Pediatrics, Division of Critical Care, University of Texas Southwestern, Dallas, TX, USA.
Pediatr Crit Care Med. 2011 Sep;12(5):504-11. doi: 10.1097/PCC.0b013e3181fe38f5.
To compare the efficacy of a low-dose methadone tapering schedule to a high-dose methadone tapering schedule in pediatric intensive care unit patients exposed to infusions of fentanyl, with or without infusions of midazolam, for ≥ 5 days.
Prospective, double-blind, randomized trial.
Pediatric intensive care unit in a tertiary care children's hospital.
Seventy-eight patients, 74 of whom had been receiving infusions of both fentanyl and midazolam, were randomized. Forty-one patients were randomized to the low-dose methadone group and 37 were randomized to the high-dose methadone group. Sixty patients successfully completed the trial, 34 were in the low-dose methadone group, and 26 were in the high-dose methadone group.
Patients were randomized to receive methadone either at a starting dose of 0.1 mg/kg/dose (low-dose methadone group) or at a starting dose based on both the patient's weight and the most recent fentanyl infusion rate (high-dose methadone group). In each group, methadone was administered every 6 hrs for the first 24 hrs and then every 12 hrs for the second 24 hrs. The methadone was then decreased to once daily and tapered off over the next 10 days. Patients were monitored for withdrawal symptoms using the Modified Narcotic Withdrawal Score.
The percentage of patients who successfully completed the 10-day methadone taper was the same in the low-dose methadone group as in the high-dose methadone group (56% vs. 62%; p = .79). Patients that failed to complete the assigned methadone taper had a greater total fentanyl dose and longer pediatric intensive care unit length of stay compared to patients who completed the assigned methadone taper.
Patients who received infusions of fentanyl for at least 5 days were just as likely to complete a low-dose methadone taper as a high-dose methadone taper. Because of the risks of both withdrawal and oversedation with any fixed methadone schedule, the methadone dose must be adjusted according to each patient's response.
比较小剂量美沙酮递减方案与大剂量美沙酮递减方案在儿科重症监护病房（PICU）中接受芬太尼输注（无论是否接受咪达唑仑输注）超过 5 天的患者中的疗效。
前瞻性、双盲、随机试验。
一家三级儿童医院的儿科重症监护病房。
78 名患者，其中 74 名患者接受芬太尼和咪达唑仑输注，随机分组。41 名患者被随机分为小剂量美沙酮组，37 名患者被随机分为大剂量美沙酮组。60 名患者成功完成试验，其中 34 名在小剂量美沙酮组，26 名在大剂量美沙酮组。
患者随机接受美沙酮治疗，起始剂量分别为 0.1mg/kg/剂量（小剂量美沙酮组）或基于患者体重和最近芬太尼输注率的起始剂量（大剂量美沙酮组）。在每组中，美沙酮在最初的 24 小时内每 6 小时给药一次，然后在接下来的 24 小时内每 12 小时给药一次。然后，美沙酮减少到每日一次，并在接下来的 10 天内逐渐减少。使用改良阿片类药物戒断评分监测患者的戒断症状。
小剂量美沙酮组和大剂量美沙酮组成功完成 10 天美沙酮递减的患者百分比相同（56%比 62%；p=0.79）。与完成指定美沙酮递减的患者相比，未能完成指定美沙酮递减的患者接受的芬太尼总剂量更大，儿科重症监护病房住院时间更长。
接受芬太尼输注至少 5 天的患者完成小剂量美沙酮递减的可能性与完成大剂量美沙酮递减的可能性相同。由于任何固定美沙酮方案都存在戒断和过度镇静的风险，美沙酮剂量必须根据每个患者的反应进行调整。
