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Tolerance, Physical Dependency, and Withdrawal

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Pediatric Critical Care Medicine

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Abstract

As clinicians in the Pediatric ICU, we have become increasingly aware of the potential adverse effects related to inadequate sedation and poor pain control. These concerns combined with ongoing humanitarian needs to provide appropriate sedation and analgesia during critical illness have led to the increased use of sedative and analgesic agents. These initiatives have also led to new consequences that must be addressed including physical dependency, tolerance, and withdrawal. Strategies are needed to identify those patients at risk for withdrawal followed by appropriate interventions to prevent or treat it. These may include a gradual tapering of the infusion rate or switching to oral or subcutaneous administration. As this is an increasing problem in the PICU setting, newer strategies to prevent its occurrence such as the use of NMDA antagonists or rotating sedation regimens warrant further investigations. With these caveats in mind, the goal of providing effective and safe sedation and analgesia for all of our patients is within reach.

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  1. Department of Anesthesiology & Pain Medicine, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH, 43205, USA

    Joseph D. Tobias MD

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Correspondence to Joseph D. Tobias MD .

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  1. Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA

    Derek S. Wheeler

  2. Div. of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA

    Hector R. Wong

  3. University of Michigan Medical School, Ann Arbor, Michigan, USA

    Thomas P. Shanley

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Tobias, J.D. (2014). Tolerance, Physical Dependency, and Withdrawal. In: Wheeler, D., Wong, H., Shanley, T. (eds) Pediatric Critical Care Medicine. Springer, London. https://doi.org/10.1007/978-1-4471-6359-6_4

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