{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T22:12:23Z","timestamp":1778623943901,"version":"3.51.4"},"reference-count":17,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2020,6,25]],"date-time":"2020-06-25T00:00:00Z","timestamp":1593043200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Anesthesia"],"published-print":{"date-parts":[[2020,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Pain control in pediatric patients undergoing cardiac surgery presents a unique challenge. Postoperatively, many of these patients require long\u2010term opioid infusions and sedation leading to need for prolonged weaning from opioids and longer hospital stays. We hypothesized that intravenous methadone as the sole opioid in children having cardiac surgery with cardiopulmonary bypass would improve perioperative pain control and decrease overall perioperative use of opioid analgesics and sedatives.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We instituted a practice change involving pediatric patients aged &lt;18\u00a0years who underwent cardiac surgery with cardiopulmonary bypass over a 14\u2010month period, comparing the patient population who had surgery prior to the institution of intraoperative methadone usage to patients who had surgery in the months following. We then separated patients into two groups: neonatal (aged\u00a0&lt;\u00a030\u00a0days) and non\u2010neonatal (aged\u00a0&gt;\u00a030\u00a0days to 18\u00a0years). Our primary outcome was intraoperative and postoperative opioid requirements measured in morphine equivalents intraoperatively, during the first 24\u00a0hours postoperatively, and up to postoperative day 7. Secondary outcomes included extubation rates in the OR, pain and sedation scores, sedation requirements, and time to start of oxycodone.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Patients in both groups had similar demographics. In neonatal patients, the postintervention group required significantly lower doses of intraoperative opioids. There was no statistically significant difference in postoperative opioid use. In non\u2010neonatal patients, the postintervention group required significantly less intraoperative opioids. Postoperatively, those in the postintervention group required significantly less opioids in the first 24\u00a0hours.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The use of intraoperative methadone appears to be a reasonable alternative to the use of fentanyl with potential other benefits both intra\u2010 and postoperatively of decreased total dose of opioids and other sedatives. Future studies will assess for any improvement in total postoperative opioid requirements during the total hospital stay, and potential use of methadone by the ICU team.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pan.13903","type":"journal-article","created":{"date-parts":[[2020,5,4]],"date-time":"2020-05-04T23:55:56Z","timestamp":1588636556000},"page":"773-779","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["The effect of intraoperative methadone during pediatric cardiac surgery on postoperative opioid requirements"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9805-5856","authenticated-orcid":false,"given":"Annika M.","family":"Barnett","sequence":"first","affiliation":[{"name":"Department of Anesthesia Duke University Medical Center Durham NC USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kelly A.","family":"Machovec","sequence":"additional","affiliation":[{"name":"Department of Anesthesia Duke University Medical Center Durham NC USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Warwick A.","family":"Ames","sequence":"additional","affiliation":[{"name":"Department of Anesthesia Duke University Medical Center Durham NC USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hercilia M.","family":"Homi","sequence":"additional","affiliation":[{"name":"Department of Anesthesia Duke University Medical Center Durham NC USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer L.","family":"Turi","sequence":"additional","affiliation":[{"name":"Pediatric Cardiac Intensive Care Unit Duke University Medical Center Durham NC USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeannie","family":"Koo","sequence":"additional","affiliation":[{"name":"Pediatric Cardiac Intensive Care Unit Duke University Medical Center Durham NC USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew","family":"Fuller","sequence":"additional","affiliation":[{"name":"Department of Anesthesia Duke University Medical Center Durham NC USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edmund H.","family":"Jooste","sequence":"additional","affiliation":[{"name":"Department of Anesthesia Duke University Medical Center Durham NC USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,6,25]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0b013e318253c80e"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0b013e3181fec9a3"},{"issue":"7","key":"e_1_2_9_4_1","first-page":"1353","article-title":"Methadone treatment for pain states","volume":"71","author":"Toombs JD","year":"2005","journal-title":"Am Fam Physician"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2016.03.023"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3476(05)81054-6"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00540-018-2541-5"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2015.10.084"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000000633"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/j.pain.0000000000000305"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1038\/jp.2009.185"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.jp.7211861"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40560-016-0189-5"},{"key":"e_1_2_9_14_1","unstructured":"SAN.Equianalgesic opioid calculator: JHH applications(Powerpoint presentation).https:\/\/www.hopkinsmedicine.org\/institute_basic_biomedical_sciences\/news_events\/Boot_Camp\/2012%20Pain\/Nesbit.ppt. 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