Opioid Withdrawal Presenting as Stridor

Abstract

Following the prolonged administration of opioids for sedation in the PICU, tolerance and physical dependency may occur. In patients who have become tolerant, physical signs of withdrawal may occur when these agents are discontinued. The actual signs and symptoms of withdrawal vary from patient to patient, but the majority of the literature documents problems such as hyperactivity of the sympathetic nervous system included tachycardia, hypertension, diaphoresis, and tremulousness. The author presents two patients who developed symptoms of upper airway obstruction, including stridor, as the major manifestation of opioid withdrawal. Operative inspection of the airway with rigid bronchoscopy and direct laryngoscopy demonstrated no airway abnormalities. Reinstitution of opioid therapy resulted in a prompt resolution of symptoms and a more gradual tapering of the opioid dose prevented recurrence of the problem.