Citations 2
Recognition and Management of Iatrogenically Induced Opioid Dependence and Withdrawal in Children: Clinical Report
Siegel, Linda, Wilder, Robert T. , Good, Julie , Reigart, J. Routt, Eckstein, Olive S. , Hindman, Diane E., Verhoef, Philip A. , Watt, Kevin , Care, Section on Critical, Hsu, Benson, Huh, Jimmy W. , Lowrie, Lia, Ndely, Simon-Noel, Satchell, Margaret A., Medicine, Section on Anesthesiology and Pain, Chatterjee, Debnath , Diaz, Christina, Drum, Elizabeth T. , Sun, Lena S. , Willer, Brittany L. , Landrigan‐Ossar, Mary, Adler, Adam C. , Goldman, Jennifer L. , Hindman, Diane E., Care, Section on Critical, Ndely, Simon-Noel, Srinivasan, Vijay , Medicine, Section on Anesthesiology and Pain, Long, Justin B.
Pediatrics | August 18, 2025 | Volume: 156 | Issue: 3 | Pages: No page available
Opioids are often prescribed to children for pain relief related to procedures, acute injuries, and chronic conditions. Around-the-clock dosing of opioids can produce physiologic opioid dependence within 5 days. According to a 2001 consensus paper from the American Academy of Pain Medicine, American Pain Society, and American Society of Addiction Medicine, dependence is defined as “a state of adaptation that is manifested by a drug class specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, or administration of an antagonist.” The experience of children undergoing iatrogenic withdrawal symptoms is variable and may be mild and go unreported or can be severe and even life threatening. Guidance on opioid withdrawal is available only for adults and primarily for adults with substance use disorders. This report will summarize existing literature and provide readers with information on how to screen for symptoms of iatrogenic opioid withdrawal as well as mechanisms for opioid withdrawal prevention.
Invasive Multimodality Neuromonitoring to Manage Cerebral Edema in Pediatric Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease
Fainberg, Nina, Silver, Maya R. , Arena, John D. , Landzberg, Elizabeth I., Banwell, Brenda , Gambrah-Lyles, Claudia , Madsen, Peter J. , McLendon, Loren , Narula, Sona , Tucker, Alexander M. , Huh, Jimmy W. , Kienzle, Martha , McLendon, Loren A , Landzberg, Elizabeth I. , Kirschen, Matthew P.
Critical Care Explorations | November 2, 2023 | Volume: 5 | Issue: 11 | Pages: e1003
Background: Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is an inflammatory disorder of the CNS with a variety of clinical manifestations, including cerebral edema. Case Summary: A 7-year-old boy presented with headaches, nausea, and somnolence. He was found to have cerebral edema that progressed to brainstem herniation. Invasive multimodality neuromonitoring was initiated to guide management of intracranial hypertension and cerebral hypoxia while he received empiric therapies for neuroinflammation. Workup revealed serum myelin oligodendrocyte glycoprotein antibodies. He survived with a favorable neurologic outcome. Conclusion: We describe a child who presented with cerebral edema and was ultimately diagnosed with MOGAD. Much of his management was guided using data from invasive multimodality neuromonitoring. Invasive multimodality neuromonitoring may have utility in managing life-threatening cerebral edema due to neuroinflammation.