Tolerance and Addiction; the patient, the parent or the clinician?

Ian Jenkins (1)

1 Paediatric Intensive Care

SUMMARY Tolerance has been recognised for some time where chronic exposure to certain drugs, particularly benzodiazepines and opioids, is associated with apparent tachyphylaxis. When these drugs are stopped or progressively reduced as in 'tapering', withdrawal symptoms result. Tolerance and the flip-side of the coin, withdrawal, are the determinants of addiction. It is increasing apparent that tolerance can occur acutely, even within the time span of a single anesthetic for a surgical procedure. Addiction is caused by agents, foreign to the body, that provoke adaptation by homeostatic biological processes. When these agents are withdrawn the adaptive mechanisms, devoid of substrate, take time to diminish and produce symptoms recognisable under the term of 'withdrawal'. Children may be exposed to these agents in different ways; in utero, as a result of substances that the mother ingests by enteral, parenteral or inhalational means that are transmitted to the infant via the placenta; as a result of an anaesthetic for surgery; or as a result of sedation and analgesia administered to offset the stresses and trauma inherent from intensive care treatment in the NICU or PICU. Additionally, anesthetic and intensive care staff are exposed to powerful and addictive drugs as part of everyday practice, not simply by overt access, but also by subliminal environmental exposure.

Mots clés: Medicine

Ian Jenkins. Tolerance and Addiction; the patient, the parent or the clinician?. Pediatric Anesthesia, 2010, 21 (7), pp.794. ⟨10.1111/j.1460-9592.2010.03501.x⟩. ⟨hal-00613821⟩