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Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
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Understanding the physiological differences in the pediatric population is crucial for effective pharmacotherapy. Neonates, infants, and children exhibit significant variations in gastric pH, gastric emptying time, intestinal transit time, and biliary function. These variations profoundly affect oral drug absorption, necessitating a nuanced approach to pediatric dosing.Neonates present with a unique physiological profile, having a gastric pH greater than 4 and faster and more irregular gastric...
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Sedatives and Hypnotics Drugs: Barbiturates01:20

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Sedatives and hypnotics encompass a drug class that acts on the central nervous system (CNS) to alleviate anxiety, promote relaxation and induce sleep.These drugs function by amplifying the actions of the neurotransmitter γ-aminobutyric acid (GABA), resulting in reduced neuronal activity. Barbiturates, a subset of sedatives and hypnotics first synthesized in the late 1800s, are categorized into ultra-short, short, intermediate, and long-acting groups based on their duration of effect. A...
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Sedation in Critically Ill Children.

Stephen Playfor1, Lara Bunni1

  • 1Paediatric Intensive Care Unit, Royal Manchester Children's Hospital, Oxford Road, Manchester M13 9WL, UK.

Journal of Clinical Medicine
|September 13, 2025
PubMed
Summary

Optimizing sedation and analgesia in critically ill children is vital for better outcomes. Evidence-based guidelines and non-pharmacological methods can improve care and reduce adverse events.

Keywords:
analgesiadeliriumpediatric intensive care (PICU)sedationtolerancewithdrawal

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Area of Science:

  • Pediatric Critical Care Medicine
  • Pharmacology

Background:

  • Sedation and analgesia are essential for managing discomfort and critical care in children.
  • Improper sedation levels (over/under) are linked to adverse events like increased mortality and longer mechanical ventilation.
  • Practices vary significantly, necessitating standardized approaches.

Purpose of the Study:

  • To review current practices in pediatric sedation and analgesia.
  • To highlight the importance of evidence-based guidelines and individualized patient care.
  • To explore the role of non-pharmacological interventions in improving outcomes.

Main Methods:

  • Review of commonly used intravenous sedative and analgesic agents (opioids, α-2 agonists, benzodiazepines, ketamine, volatile anesthetics).
  • Discussion of validated clinical tools for assessing sedation, withdrawal, and delirium.
  • Exploration of non-pharmacological interventions (family presence, music, virtual reality).

Main Results:

  • Oversedation/undersedation correlates with poor patient outcomes.
  • Standardized guidelines and judicious drug use are recommended.
  • Non-pharmacological methods can supplement pharmacologic management.
  • Daily interruption of sedatives and protocolized management show potential benefits but require further research.

Conclusions:

  • Optimizing sedation and analgesia in critically ill children requires a multi-faceted approach.
  • Adopting evidence-based guidelines and integrating non-pharmacological interventions can enhance patient outcomes.
  • Further research is crucial to refine sedation and analgesia strategies for this vulnerable population.