2024 Volume 31 Issue 4 Pages 261-265
Long-term sedation in pediatric patients can lead to drug tolerance and iatrogenic withdrawal syndrome (IWS). The patient was a 14-year-old male. He was diagnosed with fulminant myocarditis and a left ventricular assist device was implanted. Midazolam, fentanyl, and dexmedetomidine were intravenously administered, and the amounts of each sedative were increased due to drug tolerance. For extubation, it was necessary to slowly taper the amount of each drug to prevent IWS, and we needed to maintain the level of sedation until extubation for safe management. We tapered the amount of midazolam and fentanyl by 5% every 12 hr. Ketamine, isoflurane, and propofol were administered as off-label drugs to maintain the target level of sedation. The patient woke up immediately after propofol discontinuation and was successfully extubated. After the discontinuation of midazolam and fentanyl, dexmedetomidine was tapered and discontinued. During the course, there were no findings that suggested propofol infusion syndrome, IWS, or malignant hyperthermia.
