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Evaluation of an updated sedation protocol to reduce benzodiazepines in a pediatric intensive care unit

Jörg Michel1, Michael Hofbeck1, Ann-Kathrin Peper1

  • 1Department of Pediatric Cardiology, Pulmonology and Pediatric Intensive Care Medicine, University Children's Hospital Tübingen, Tübingen, Germany.

Current Medical Research and Opinion
|September 19, 2019
PubMed

Insights

A modified sedation protocol successfully reduced midazolam use in infants after heart surgery. This approach is safe and effective for managing pediatric pain and delirium, ensuring adequate sedation without adverse effects.

Area of Science:

  • Pediatric Cardiology
  • Pediatric Anesthesiology
  • Neonatal Intensive Care

Background:

  • Midazolam, a benzodiazepine, may pose neurotoxic risks and increase delirium risk in young children.
  • Reducing midazolam exposure is crucial for vulnerable infant populations, especially post-cardiac surgery.

Purpose of the Study:

  • To assess the feasibility and effectiveness of a modified analgesia and sedation protocol.
  • To reduce midazolam requirements in neonates and young infants following cardiac surgery.

Main Methods:

  • A pre-modification and post-modification group design comparing infants aged ≤6 months undergoing cardiac surgery with cardiopulmonary bypass.
  • Assessment of midazolam, morphine, and clonidine doses, sedation scores, withdrawal symptoms, and pediatric delirium over 120 hours post-surgery.

Main Results:

  • A significant reduction in the number of patients receiving midazolam and the cumulative midazolam dose was achieved.
  • Sedation scores remained within the target range, indicating adequate sedation.
  • No negative side effects or increased incidence of withdrawal symptoms or delirium were observed.

Conclusions:

  • Implementing a modified nurse-driven analgesia and sedation protocol is feasible and safe.
  • The protocol effectively reduces midazolam use in infants post-cardiac surgery while maintaining optimal sedation.
  • This strategy supports improved patient outcomes by minimizing potential benzodiazepine-related neurotoxicity.

Keywords:
Cardiac surgeryanalgesiacongenital heart diseasenurse-driven protocolpediatric deliriumwithdrawal

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