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Published on: September 24, 2020
Sedation and analgesia in pediatric intensive care
Carmelo Minardi1, Emre Sahillioğlu, Marinella Astuto
1Department of Experimental Medicine, Milan Bicocca University. Italy.
Insights
Pediatric intensive care units (PICUs) commonly use analgesia and sedation for pain management and patient comfort. Developing individualized plans and utilizing validated tools are crucial for effective sedation, with EEG monitoring showing potential but lacking routine evidence.
Area of Science:
- Pediatric Intensive Care
- Pain Management
- Sedation Therapeutics
Background:
- Children in the pediatric intensive care unit (PICU) require analgesia and sedation for pain control and to facilitate care.
- Commonly used agents include Morphine or Fentanyl, often with Midazolam.
- Alternative strategies like regional anesthesia and patient-controlled analgesia can reduce intravenous drug use and withdrawal symptoms.
Purpose of the Study:
- To review the principles and practices of analgesia and sedation in the PICU.
- To highlight the importance of individualized therapeutic plans and regular review.
- To discuss assessment tools and emerging monitoring technologies.
Main Methods:
- Review of current practices in pediatric intensive care analgesia and sedation.
- Discussion of commonly used pharmacological agents and alternative techniques.
- Evaluation of sedation assessment tools and the role of EEG monitoring.
Main Results:
- Individualized, regularly reviewed therapeutic plans are essential for pediatric analgesia and sedation.
- Validated sedation assessment tools are recommended, but may be limited during neuromuscular blockade.
- While EEG monitoring shows promise for sedation assessment, routine use of BIS monitoring in PICU is not yet supported by sufficient evidence.
Conclusions:
- Effective management of analgesia and sedation in PICU requires tailored plans and regular reassessment.
- Validated tools are important for monitoring sedation levels, with limitations noted during neuromuscular blockade.
- Further research is needed to establish the routine utility of advanced monitoring like EEG-based BIS in PICU settings.
Abstract:
Almost all children in the pediatric intensive care (PICU) need analgesia and/or sedation. Analgesics drugs are used to control pain from surgical incisions, drainages, vascular access or endotracheal suctioning. Sedatives are used to facilitate the delivery of nursing care, to facilitate mechanical ventilation, prevent self-extubation and to minimize patient discomfort. A therapeutic plan for analgesia and sedation should be established for each patient and regularly reviewed. The most often used sedation agents in PICU patients are Morphine or Fentanyl alone or in combination with Midazolam. Several other drugs should be helpful to manage PICU patients therefore techniques like regional anesthesia and patient controlled analgesia to decrease the use of intravenous analgesia and sedation and to reduce the incidence of withdrawal syndrome. The therapeutic plan for analgesia and sedation should be established for each patient and regularly reviewed. Doses of sedative agents should be titrated to produce the desired level of sedation. The level of sedation should be regularly assessed and documented using few validated sedation assessment tool. However, behavioral evaluation tools based on patient responsiveness, cannot be used during the administration of neuromuscular blocking agents. Under this conditions it could be difficult to interpret the degree of sedation. EEG derived Monitoring devices may represents an useful tools of assessing the level of sedation, but there is insufficient evidence to support the routine use of the BIS monitor in PICU.
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