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1However, prolonged exposure to opioids followed by abrupt cessation frequently leads to opioid withdrawal syndrome. 2,3 This syndrome is present in 35% to 57% of children who have received fentanyl by continuous infusion. 4-6 It is characterized by a hyperadrenergic response following the abrupt reduction in opioid dosage, with clinical symptoms that include irritability, tremors, twitching, gastroin testinal disturbances, hypertension, and fever. 4-6 The dose and duration of opioid use influence the development of opioid withdrawal symptoms. 4,5,7 However, proper pharmacologic management of withdrawal is still controversial, and there is little evidence upon which to base recommendations regarding prevention, assessment, and management of withdrawal in critically ill children. 8

Use of Methadone for Opioid Weaning in Children: Prescribing Practices and Trends