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Continuing Education in Anaesthesia, Critical Care & Pain Advance Access originally published online on May 2, 2008
Continuing Education in Anaesthesia, Critical Care & Pain 2008 8(3):90-94; doi:10.1093/bjaceaccp/mkn011
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© The Board of Management and Trustees of the British Journal of Anaesthesia [2008]. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Analgesia and sedation in critically ill children

Stephen D. Playfor, MD
Consultant Paediatric Intensivist
Paediatric Intensive Care Unit
Royal Manchester Children's Hospital
Hospital Road
Pendlebury
Manchester M27 4HA
UK
Tel: +44 161 922 2978 Fax: +44 161 922 2198 E-mail: stephen.playfor@cmmc.nhs.uk

Key Words: Adequate analgesia should be provided to all critically ill children, regardless of the need for sedation. • Morphine and midazolam remain the most commonly used analgesic and sedative agents, respectively, in the UK. • Regular assessment of pain and sedation levels using appropriate tools is recommended in the paediatric intensive care unit. • There are no proven evidence-based techniques to prevent the incidence of withdrawal syndrome.

The first 150 words of the full text of this article appear below.

Effective analgesia and sedation for critically ill children involve caring for both their physical and psychological comfort. All critically ill children in a paediatric intensive care unit (PICU) have the right to adequate pain relief. Any correctable environmental and physical factors causing discomfort should be addressed before the introduction of pharmacological agents: a normal pattern of sleep should be encouraged, and attention should be paid to the provision of feeding and hydration, lighting, environmental noise, and the temporal orientation of patients.

Once an adequate level of analgesia has been achieved, additional sedative agents may be required by some children. The aims of sedation are to reduce anxiety and distress in the child, and to allow for better tolerance of therapeutic and diagnostic procedures. Facilitation of mechanical ventilation is particularly important with the application of less physiological ventilatory modes such as high-frequency oscillatory ventilation, controlled hypoventilation, and tracheal gas insufflation. Further . . . [Full Text of this Article]


   Current practice
 

   Analgesic agents
 
Regional analgesia

Opioids

Morphine

Fentanyl

Remifentanil

NSAIDs and paracetamol


   Sedative agents
 
Benzodiazepines

Midazolam

Clonidine

Enteral sedative agents


   Assessment of analgesia and sedation
 
Pain assessment

Sedation assessment

Neurophysiological monitors


   Clinical practice guidelines
 

   Withdrawal syndrome
 

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