ReviewPediatrics2010
Tolerance and withdrawal from prolonged opioid use in critically ill children.
Review in Pediatrics, 2010. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04904965 (Frontal Electroencephalography of Neonatal Patients Under Sedation With Opioids and General Anesthesia With Propofol.), which is not on this map. Cited by 107 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Frontal Electroencephalography of Neonatal Patients Under Sedation With Opioids and General Anesthesia With Propofol.
Who cites it
107 citing papers in PubMed, 4 syntheses or guidelines pooled it, 318 citations in OpenAlex.
- Opioid equipotency conversions for hospitalized infants: a systematic review.Journal of perinatology : official journal of the California Perinatal Association · 2024Pooled it
- Assessment and treatment of the withdrawal syndrome in paediatric intensive care units: Systematic review.Medicine · 2020Pooled it
- Risk factors associated with iatrogenic opioid and benzodiazepine withdrawal in critically ill pediatric patients: a systematic review and conceptual model.Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies · 2015Pooled it
- Strategies for the management and prevention of withdrawal syndrome in critically ill pediatric patients: a systematic review.Revista Brasileira de terapia intensivaPooled it
- Sedative and Analgesic Drug Rotation Protocol Versus Non-Rotation Protocol in Mechanically Ventilated Children: A Randomised Controlled Trial.Indian journal of pediatrics · 2025Trial
- Sedation Management in Children Supported on Extracorporeal Membrane Oxygenation for Acute Respiratory Failure.Critical care medicine · 2017Trial
- Patterns of Sedation Weaning in Critically Ill Children Recovering From Acute Respiratory Failure.Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies · 2016Trial
- Trial
- Opioid and Methadone Prescribing for Infants with Surgical Management of Congenital Heart Disease.Pediatric cardiology · 2026Observational
- Analgesia and sedation in premature infants receiving invasive ventilation: a systematic scoping review.Pediatric research · 2026Article
- Fentanyl Utilization During Extracorporeal Membrane Oxygenation and Risk of Methadone Treatment Among Pediatric ECMO Survivors.Pediatric surgery international · 2026Article
- Analgesia and sedation trends in a level IV NICU, 2014-2024: Opioid and dexmedetomidine use.Journal of perinatology : official journal of the California Perinatal Association · 2026Article
- Protocolized vs. Conventional Sedation Among Mechanically Ventilated Children in a Pediatric Intensive Care Unit - A Pre-Post Study.Indian journal of pediatrics · 2026Article
- The Association of Iatrogenic Withdrawal With Opioid and Benzodiazepine Weaning in Children With Bronchiolitis: A Single-Center, Retrospective Cohort Study, 2012-2022.Critical care explorations · 2026Article
- Strategies for a Rational Use of Opioids in Critical Care Settings.Journal of clinical medicine · 2026Review
- Personalizing ICU liberation for critically Ill children: shaping the future of the ABCDEF bundle.Current opinion in pediatrics · 2025Review
- Protocolized sedation may reduce ventilation and sedation requirements in the pediatric intensive care unit: a systematic review and meta-analysis.Clinical and experimental pediatrics · 2025Article
- Intraoperative Methadone Versus Non-Methadone Analgesia in Pediatric Cardiac Surgery: A Retrospective Cohort Study.Children (Basel, Switzerland) · 2025Article
- Pathophysiology and management of burn injury-induced pain.Burns open : an international open access journal for burn injuries · 2025Article
- Verifying the Japanese Version of Pediatric Delirium and Withdrawal Syndrome Assessment Scale: SOS-PD Validation Study for Iatrogenic Withdrawal Syndrome.Children (Basel, Switzerland) · 2025Article
47 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
12 authors at 11 institutions in 1 country.
Funding
Abstract
objectiveAfter prolonged opioid exposure, children develop opioid-induced hyperalgesia, tolerance, and withdrawal. Strategies for prevention and management should be based on the mechanisms of opioid tolerance and withdrawal. PATIENTS AND
methodsRelevant manuscripts published in the English language were searched in Medline by using search terms "opioid," "opiate," "sedation," "analgesia," "child," "infant-newborn," "tolerance," "dependency," "withdrawal," "analgesic," "receptor," and "individual opioid drugs." Clinical and preclinical studies were reviewed for data synthesis.
resultsMechanisms of opioid-induced hyperalgesia and tolerance suggest important drug- and patient-related risk factors that lead to tolerance and withdrawal. Opioid tolerance occurs earlier in the younger age groups, develops commonly during critical illness, and results more frequently from prolonged intravenous infusions of short-acting opioids. Treatment options include slowly tapering opioid doses, switching to longer-acting opioids, or specifically treating the symptoms of opioid withdrawal. Novel therapies may also include blocking the mechanisms of opioid tolerance, which would enhance the safety and effectiveness of opioid analgesia.
conclusionsOpioid tolerance and withdrawal occur frequently in critically ill children. Novel insights into opioid receptor physiology and cellular biochemical changes will inform scientific approaches for the use of opioid analgesia and the prevention of opioid tolerance and withdrawal.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.