{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,4]],"date-time":"2026-04-04T09:47:24Z","timestamp":1775296044758,"version":"3.50.1"},"reference-count":40,"publisher":"FapUNIFESP (SciELO)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rev. Assoc. Med. Bras."],"abstract":"<jats:p>SUMMARY OBJECTIVE: Opioid abstinence syndrome is common in the pediatric intensive care environment because sedation is often needed during the children's treatment. There is no specific guideline regarding the management of these patients; and lately, methadone is an important drug for the prevention of abstinence symptoms during the weaning of opioids. This study gathers the available research to establish the initial dose of methadone, the rate of taper and tools to recognize this syndrome and act promptly. METHODS: A systematic review was made from data of four different databases. Forty-nine articles of observational and experimental studies were selected based on the inclusion criteria (critical pediatric patients in acute use of opioids) and exclusion criteria (previous chronic use of opioids, other medications). The data regarding specific themes were separated in sections: initial dose of methadone, use of protocols in clinical practice, abstinence scales and adjuvant drugs. RESULTS: The articles showed a great heterogeneity of ways to calculate the initial dose of methadone. The pediatric intensive care units of the study had different weaning protocols, with a lower incidence of abstinence when a pre-defined sequence of tapering was used. The Withdrawal Assessment Tool \u2013 1 was the most used scale for tapering the opioids, with good sensitivity and specificity for signs and symptoms. CONCLUSION: There is still little evidence of other medications that can help prevent the abstinence syndrome of opioids. This study tries to promote a better practice during opioid weaning.<\/jats:p>","DOI":"10.1590\/1806-9282.64.10.909","type":"journal-article","created":{"date-parts":[[2018,12,4]],"date-time":"2018-12-04T11:50:26Z","timestamp":1543924226000},"page":"909-915","source":"Crossref","is-referenced-by-count":4,"title":["Opioid tapering and weaning protocols in pediatric critical care units: a systematic review"],"prefix":"10.1590","volume":"64","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6844-3332","authenticated-orcid":false,"given":"Pedro","family":"Bichaff","sequence":"first","affiliation":[{"name":"USP, Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karina T","family":"Setani","sequence":"additional","affiliation":[{"name":"USP, Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emiliana H. G","family":"Motta","sequence":"additional","affiliation":[{"name":"USP, Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Artur F","family":"Delgado","sequence":"additional","affiliation":[{"name":"USP, Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Werther B","family":"Carvalho","sequence":"additional","affiliation":[{"name":"USP, Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michele","family":"Luglio","sequence":"additional","affiliation":[{"name":"USP, Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"530","published-online":{"date-parts":[[2018,10]]},"reference":[{"issue":"2","key":"ref1","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1097\/00003246-199402000-00027","article-title":"Opioid tolerance and dependence in infants and children","volume":"22","author":"Anand KJ","year":"1994","journal-title":"Crit Care Med"},{"issue":"5","key":"ref2","doi-asserted-by":"crossref","first-page":"e1208","DOI":"10.1542\/peds.2009-0489","article-title":"Tolerance and withdrawal from prolonged opioid use in critically Ill children","volume":"125","author":"Anand KJ","year":"2010","journal-title":"Pediatrics"},{"issue":"6","key":"ref3","doi-asserted-by":"crossref","first-page":"2122","DOI":"10.1097\/00003246-200006000-00079","article-title":"Tolerance, withdrawal, and physical dependency after longterm sedation and analgesia of children in the pediatric intensive care unit","volume":"28","author":"Tobias JD","year":"2000","journal-title":"Crit Care Med"},{"issue":"8","key":"ref4","doi-asserted-by":"crossref","first-page":"786","DOI":"10.1111\/pan.12649","article-title":"Nurse-driven pediatric analgesia and sedation protocol reduces withdrawal symptoms in critically ill medical pediatric patients","volume":"25","author":"Neunhoeffer F","year":"2015","journal-title":"Pediatric Anesth"},{"issue":"6","key":"ref5","first-page":"602","article-title":"Import\u00e2ncia do uso de protocolos para manejo da analgesia e seda\u00e7\u00e3o em unidade de terapia intensiva pedi\u00e1trica","volume":"62","author":"Motta E","year":"2016","journal-title":"Rev Assoc Med Bras"},{"issue":"1","key":"ref6","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1016\/0197-2456(94)00031-W","article-title":"Assessing the quality of randomized controlled trials: an annotated bibliography of scales and checklists","volume":"16","author":"Moher D","year":"1995","journal-title":"Control Clin Trials"},{"issue":"1","key":"ref7","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/0197-2456(95)00134-4","article-title":"Assessing the quality of reports of randomized clinical trials: is blinding necessary?","volume":"17","author":"Jadad AR","year":"1996","journal-title":"Control Clin Trials."},{"issue":"5","key":"ref8","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1097\/PCC.0b013e3181fe38f5","article-title":"A trial of methadone tapering schedules in pediatric intensive care unit patients exposed to prolonged sedative infusions","volume":"12","author":"Bowens CD","year":"2011","journal-title":"Pediatr Crit Care Med"},{"issue":"12","key":"ref9","doi-asserted-by":"crossref","first-page":"1566","DOI":"10.1592\/phco.21.20.1566.34471","article-title":"Enteral methadone to expedite fentanyl discontinuation and prevent opioid abstinence syndrome in the PICU","volume":"21","author":"Lugo RA","year":"2001","journal-title":"Pharmacotherapy"},{"issue":"2","key":"ref10","first-page":"105","article-title":"Evaluation of initial methadone dosing for prevention of iatrogenic opioid abstinence syndrome in children","volume":"1","author":"Johnson PN","year":"2012","journal-title":"J Pediatr Intensive Care"},{"issue":"9","key":"ref11","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1046\/j.1460-9592.2003.01153.x","article-title":"Methadone dosage for prevention of opioid withdrawal in children","volume":"13","author":"Siddappa R","year":"2003","journal-title":"Paediatr Anaesth"},{"issue":"1","key":"ref12","doi-asserted-by":"crossref","first-page":"12","DOI":"10.4212\/cjhp.v65i1.1098","article-title":"Use of methadone for prevention of opioid withdrawal in critically Ill children","volume":"65","author":"Jeffries SA","year":"2012","journal-title":"Can J Hosp Pharm"},{"issue":"4","key":"ref13","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1097\/00130478-200110000-00009","article-title":"Efficacy of an enteral 10-day methadone wean to prevent opioid withdrawal in fentanyl-tolerant pediatric intensive care unit patients","volume":"2","author":"Meyer MM","year":"2001","journal-title":"Pediatr Crit Care Med"},{"issue":"2","key":"ref14","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1097\/00130478-200010000-00005","article-title":"Evaluation of an opiate-weaning protocol using methadone in pediatric intensive care unit patients","volume":"1","author":"Robertson RC","year":"2000","journal-title":"Pediatr Crit Care Med"},{"issue":"4","key":"ref15","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1213\/01.ane.0000202395.94542.3e","article-title":"A prospective evaluation of opioid weaning in opioid-dependent pediatric critical care patients","volume":"102","author":"Berens RJ","year":"2006","journal-title":"Anesth Analg"},{"issue":"3","key":"ref16","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1097\/PCC.0000000000000048","article-title":"Evaluation of a pharmacist-managed methadone taper","volume":"15","author":"Steineck KJ","year":"2014","journal-title":"Pediatr Crit Care Med"},{"issue":"1","key":"ref17","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1097\/PCC.0000000000000572","article-title":"Patterns of sedation weaning in critically ill children recovering from acute respiratory failure","volume":"17","author":"Best KM","year":"2016","journal-title":"Pediatr Crit Care Med"},{"issue":"12","key":"ref18","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1097\/01.ccm.0000474667.00307.c0","article-title":"Implementation of an opioid and benzodiazepine withdrawal prevention protocol in a PICU","volume":"43","author":"Sanchez-Pinto L","year":"2015","journal-title":"Crit Care Med"},{"issue":"3","key":"ref19","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/j.iccn.2004.09.003","article-title":"A prospective study of adverse reactions to the weaning of opioids and benzodiazepines among critically ill children","volume":"21","author":"Ducharme C","year":"2005","journal-title":"Intensive Crit Care Nurs"},{"issue":"8","key":"ref20","doi-asserted-by":"crossref","first-page":"1396","DOI":"10.1007\/s00134-007-0696-x","article-title":"Withdrawal symptoms in children after long-term administration of sedatives and\/or analgesics: a literature review. \u201cAssessment remains troublesome\u201d","volume":"33","author":"Ista E","year":"2007","journal-title":"Intensive Care Med"},{"issue":"5","key":"ref21","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1097\/00003246-199405000-00009","article-title":"Prospective study on the occurrence of withdrawal in critically ill children who receive fentanyl by continuous infusion","volume":"22","author":"Katz R","year":"1994","journal-title":"Crit Care Med"},{"issue":"6","key":"ref22","doi-asserted-by":"crossref","first-page":"1075","DOI":"10.1007\/s00134-009-1487-3","article-title":"Construction of the Sophia Observation withdrawal Symptoms-scale (SOS) for critically ill children","volume":"35","author":"Ista E","year":"2009","journal-title":"Intensive Care Med"},{"issue":"8","key":"ref23","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1097\/PCC.0b013e31829f5be1","article-title":"Psychometric evaluation of the Sophia Observation withdrawal symptoms scale in critically ill children","volume":"14","author":"Ista E","year":"2013","journal-title":"Pediatr Crit Care Med"},{"issue":"1","key":"ref24","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1016\/j.pain.2011.10.003","article-title":"Validity and generalizability of the Withdrawal Assessment Tool-1 (WAT-1) for monitoring iatrogenic withdrawal syndrome in pediatric patients","volume":"153","author":"Franck LS","year":"2012","journal-title":"Pain"},{"issue":"6","key":"ref25","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1097\/PCC.0b013e31818c8328","article-title":"The Withdrawal Assessment Tool-1 (WAT-1): an assessment instrument for monitoring opioid and benzodiazepine withdrawal symptoms in pediatric patients","volume":"9","author":"Franck LS","year":"2008","journal-title":"Pediatr Crit Care Med"},{"issue":"6","key":"ref26","doi-asserted-by":"crossref","first-page":"1658","DOI":"10.1213\/01.ANE.0000113547.34160.A5","article-title":"The use of dexmedetomidine to facilitate opioid and benzodiazepine detoxification in an infant","volume":"98","author":"Finkel JC","year":"2004","journal-title":"Anesth Analg"},{"issue":"7","key":"ref27","first-page":"593","article-title":"Prevention of opioid withdrawal syndrome after pediatric heart transplantation: usefulness of dexmedetomidine","volume":"66","author":"Vega L","year":"2013","journal-title":"Rev Esp Cardiol (Engl Ed)"},{"issue":"2","key":"ref28","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1177\/0885066604273481","article-title":"Dexmedetomidine in the treatment of withdrawal syndromes in cardiothoracic surgery patients","volume":"20","author":"Baddigam K","year":"2005","journal-title":"J Intensive Care Med"},{"issue":"4","key":"ref29","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1300\/J069v19n04_05","article-title":"Ultrarapid opioid detoxification of two children with congenital heart disease","volume":"19","author":"Greenberg M","year":"2000","journal-title":"J Addict Dis"},{"issue":"1","key":"ref30","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1542\/peds.98.1.135","article-title":"The management of opioid and benzodiazepine dependence in infants, children, and adolescents","volume":"98","author":"Yaster M","year":"1996","journal-title":"Pediatrics"},{"issue":"10","key":"ref31","doi-asserted-by":"crossref","first-page":"2262","DOI":"10.1097\/00003246-199910000-00033","article-title":"Subcutaneous administration of fentanyl and midazolam to prevent withdrawal after prolonged sedation in children","volume":"27","author":"Tobias JD","year":"1999","journal-title":"Crit Care Med"},{"issue":"11","key":"ref32","doi-asserted-by":"crossref","first-page":"1292","DOI":"10.1097\/00003246-199011000-00024","article-title":"Methadone as treatment for iatrogenic narcotic dependency in pediatric intensive care unit patients","volume":"18","author":"Tobias JD","year":"1990","journal-title":"Crit Care Med"},{"issue":"6","key":"ref33","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1016\/j.hrtlng.2013.07.008","article-title":"Opioid withdrawal signs and symptoms in children: frequency and determinants","volume":"42","author":"Fisher D","year":"2013","journal-title":"Heart Lung"},{"issue":"2","key":"ref34","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1097\/PCC.0000000000000327","article-title":"Opioid and benzodiazepine withdrawal syndrome: can we predict and prevent It?","volume":"16","author":"Ista E","year":"2015","journal-title":"Pediatr Crit Care Med"},{"issue":"1","key":"ref35","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1111\/j.1478-5153.2008.00311.x","article-title":"Opioid and benzodiazepine withdrawal syndromes in the pediatric intensive care unit: a review of recent literature","volume":"14","author":"Birchley G","year":"2009","journal-title":"Nurs Crit Care"},{"issue":"12","key":"ref36","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1097\/01.ccm.0000474618.25856.05","article-title":"Implementation of a withdrawal prevention protocol in a pediatric cardiac ICU","volume":"43","author":"Amirnovin R","year":"2015","journal-title":"Crit Care Med"},{"issue":"5","key":"ref37","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1097\/PCC.0b013e318202f58d","article-title":"Creating or preventing opioid addiction, finding the right dose","volume":"12","author":"Ista E","year":"2011","journal-title":"Pediatr Crit Care Med"},{"issue":"2","key":"ref38","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1002\/PHAR.1001","article-title":"Selection of the initial methadone regimen for the management of iatrogenic opioid abstinence syndrome in critically ill children","volume":"32","author":"Johnson PN","year":"2012","journal-title":"Pharmacotherapy"},{"issue":"3","key":"ref39","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1111\/pan.13056","article-title":"The use of methadone to facilitate opioid weaning in pediatric critical care patients: a systematic review of the literature and meta-analysis","volume":"27","author":"Dervan LA","year":"2017","journal-title":"Paediatr Anaesth"},{"issue":"2","key":"ref40","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1097\/ADM.0000000000000197","article-title":"Opioid and benzodiazepine withdrawal syndrome in PICU patients: which risk factors matter?","volume":"10","author":"Silva PS","year":"2016","journal-title":"J Addict Med."}],"container-title":["Revista da Associa\u00e7\u00e3o M\u00e9dica Brasileira"],"original-title":[],"link":[{"URL":"http:\/\/www.scielo.br\/pdf\/ramb\/v64n10\/1806-9282-ramb-64-10-0909.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,4]],"date-time":"2026-04-04T08:54:19Z","timestamp":1775292859000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.scielo.br\/scielo.php?script=sci_arttext&pid=S0104-42302018001000909&lng=en&tlng=en"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,10]]},"references-count":40,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2018,10]]}},"alternative-id":["S0104-42302018001000909"],"URL":"https:\/\/doi.org\/10.1590\/1806-9282.64.10.909","relation":{},"ISSN":["1806-9282","0104-4230"],"issn-type":[{"value":"1806-9282","type":"electronic"},{"value":"0104-4230","type":"print"}],"subject":[],"published":{"date-parts":[[2018,10]]}}}