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Pediatric Critical Care Study Guide pp 382–405Cite as

Sedation and Analgesia

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Abstract

Significant pain and anxiety often accompanies many forms of critical illness. The physiologic stress induced by pain and agitation can impede recovery and the delivery of critical care. Additionally, sedation of children may be required to maintain invasive devices often necessary for the monitoring and care of the critically ill or injured child. A thorough understanding of pain physiology and drug pharmacology is necessary to provide analgesia and anxiolysis.

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Suggested Readings

  • Ambuel B, Hamlet KW, Marx CM, et al. Assessing distress in pediatric intensive care environments: the COMFORT scale. J Pediatr Psychol. 1992;17:95–109.

    Article  PubMed  CAS  Google Scholar 

  • American Academy of Pediatrics. Committee on drugs. Neonatal drug withdrawal. Pediatrics. 1998;101:1079–88.

    Google Scholar 

  • American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists. Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology. 2002;96(4):1004–17.

    Article  Google Scholar 

  • Anand KJ, Willson DF, Berger J, Harrison R, Meert KL, Zimmerman J, et al. Tolerance and withdrawal from prolonged opioid use in critically ill children. Pediatrics. 2010;125(5):e1208–25. Epub Apr 19, 2010.

    Article  PubMed  Google Scholar 

  • Aneja R, Heard AM, et al. Sedation monitoring of children by the bispectral index in the pediatric intensive care unit. Pediatr Crit Care Med. 2003;4:60–4.

    Article  PubMed  Google Scholar 

  • Barbi E, et al. Deep sedation with propofol by non-anesthesiologists. Arch Pediatr Adolesc Med. 2003;157:1097–1103.

    Article  PubMed  Google Scholar 

  • Bar-Joseph G, et al. Effectiveness of ketamine in decreasing intracranial pressure in children with intracranial hypertension. J Neurosurg Pediatr. 2009;4:40–6.

    Article  PubMed  Google Scholar 

  • Berde CB, Sethna NF. Analgesics for the treatment of pain in children. N Engl J Med. 2002;347:1094–1103.

    Article  PubMed  CAS  Google Scholar 

  • Courman SP, et al. Comparison of bispectral index monitor with the comfort score in assessing level of sedation of critically ill children. Intensive Care Med. 2003;29:2239–46.

    Article  Google Scholar 

  • Cravero JP, et al. Incidence and nature of adverse events during pediatric sedation/anesthesia for procedures outside the operating room: report from the pediatric sedation research consortium. Pediatrics. 2006;118(3):1087–96.

    Article  PubMed  Google Scholar 

  • Detriche O, et al. The Brussels sedation scale: use of a simple clinical sedation scale can avoid excessive sedation in patients undergoing mechanical ventilation in the intensive care unit. Br J Anaesth. 1999;83:698–701.

    PubMed  CAS  Google Scholar 

  • Deutshc ES, Nadkarni VM. Clonidine prophylaxis for narcotic and sedative withdrawal syndrome following laryngotracheal reconstruction. Arch Otolaryngol Head Neck Surg. 1996;122:1234–8.

    Article  Google Scholar 

  • Devlin JW, Roberts RJ. Pharmacology of commonly used analgesics and sedatives in the ICU: benzodiazepines, propofol, and opioids. Crit Care Clin. 2009;25(3):431–49. vii. Review.

    Article  PubMed  CAS  Google Scholar 

  • Franck LS, et al. Opioid and benzodiazepine withdrawal symptoms in paediatric intensive care patients. Intensive Crit Care Nurs. 2004;20: 344–51.

    Article  PubMed  Google Scholar 

  • Franck LS, et al. The Withdrawal Assessment Tool-1 (WAT-1): an assessment instrument for monitoring opioid and benzodiazepine withdrawal symptoms in pediatric patients. Pediatr Crit Care Med. 2008;9(6):573–80.

    Article  PubMed  Google Scholar 

  • Hatch DJ. Propofol-infusion syndrome in children. Lancet. 1999;353:1117–8.

    Article  PubMed  CAS  Google Scholar 

  • Ista E, van Dijk M, de Hoog M, Tibboel D, Duivenvoorden HJ. Construction of the Sophia observation withdrawal symptoms-scale (SOS) for critically ill children. Intensive Care Med. 2009;35:1075–81.

    Article  PubMed  Google Scholar 

  • Lambert RL, Freeman AL, Maffei FA. Safety of propofol sedation in children with food allergy. SCCM annual congress. Feb 4-8, 2012, Houston, TX. (SCCM abstract no. 833). Crit Care Med. 2011;39(12)(Supplement):234.

    Article  PubMed  CAS  Google Scholar 

  • Maxwell LG, et al. The effects of a small dose naloxone infusion on opioid induced side effects and analgesia in children and adolescents treated with intravenous patient controlled analgesia: a double blind, prospective, randomized, controlled study. Anesth Analg. 2005;100:953–8.

    Article  PubMed  CAS  Google Scholar 

  • Multz AS. Prolonged dexmedetomidine infusion as an adjunct in treating sedation-induced withdrawal. Anesth Analg. 2003;96(4): 1054–5.

    Article  PubMed  Google Scholar 

  • Nahata MC. Safety of “inert” additives or excipients in paediatric medicines. Arch Dis Child Fetal Neonatal Ed. 2009;94(6): F392–3.

    Article  PubMed  Google Scholar 

  • Panzer O, Moitra V, Sladen RN. Pharmacology of sedative-analgesic agents: dexmedetomidine, remifentanil, ketamine, volatile anesthetics, and the role of peripheral mu antagonists. Crit Care Clin. 2009;25(3):451–69. vii.

    Article  PubMed  CAS  Google Scholar 

  • Pate MF, Steelman R. Questions unanswered: propofol use in the pediatric intensive care unit. AACN Adv Crit Care. 2007;18(3):248–52. Review.

    Article  PubMed  Google Scholar 

  • Reich DL, Sivay G. Ketamine: an update on the first twenty five years of clinical experience. Can J Anaesth. 1989;36:189.

    Article  Google Scholar 

  • Reves JG, et al. Midazolam: pharmacology and uses. Anesthesiology. 1985;62:310–7.

    Article  PubMed  CAS  Google Scholar 

  • Rutman MS. Sedation for emergent diagnostic imaging studies in pediatric patients. Curr Opin Pediatr. 2009;21(3):306–12.

    Article  PubMed  Google Scholar 

  • Secgin S, et al. Determination of difficult intubation in the ED. Am J Emerg Med. 2009;27(8):905–10.

    Article  Google Scholar 

  • Shehab N, et al. Exposure to the pharmaceutical excipients benzyl alcohol and propylene glycol among critically ill neonates. Pediatr Crit Care Med. 2009;10(2):256–9.

    Article  PubMed  Google Scholar 

  • Shukry M, Miller JA. Update on dexmedetomidine: use in nonintubated patients requiring sedation for surgical procedures. Ther Clin Risk Manag. 2010;6:111–21.

    Article  PubMed  CAS  Google Scholar 

  • Siddappa R, et al. Methadone dosage for prevention of opioid withdrawal in children. Paediatr Anaesth. 2003;13:805–10.

    Article  PubMed  Google Scholar 

  • Spagrud LJ, et al. Children’s self report of pain intensity. Am J Nurs. 2003;103:62–4.

    Article  PubMed  Google Scholar 

  • Tobias JD. Sedation and analgesia in paediatric intensive care units: a guide to drug selection and use. Paediatr Drugs. 1999;1(2): 109–26.

    Article  PubMed  CAS  Google Scholar 

  • Tobias JD. Tolerance, withdrawal, and physical dependency after long term sedation and analgesia of children in the pediatric intensive care unit. Crit Care Med. 2000;28:2122–32.

    Article  PubMed  CAS  Google Scholar 

  • Tunik M, Treiber M, Karpeles T, Kim J, Cooper A, Foltin G. Teaching Resource for Instructors in Prehospital Pediatrics (TRIPP BLS), 2nd Edition, Center for Pediatric Emergency Medicine, CD, HRSA, 2006.

    Google Scholar 

  • Vespasiano M, et al. Propofol sedation: intensivist’s experience with 7304 cases in a children’s hospital. Pediatrics. 2007;120(2): 1411–7.

    Article  Google Scholar 

  • Wilson KC, et al. Propylene glycol toxicity: a severe iatrogenic illness in ICU patients receiving IV benzodiazepines: a case series and prospective, observational pilot study. Chest. 2005;128(3): 1674–81.

    Article  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Pediatric Critical Care Medicine, Department of Pediatrics, Geisinger Medical Center, Temple University School of Medicine, Janet Weis Children’s Hospital, Danville, PA, USA

    Richard L. Lambert M.D., Lela W. Brink M.D. & Frank A. Maffei M.D.

Authors
  1. Richard L. Lambert M.D.
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  2. Lela W. Brink M.D.
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  3. Frank A. Maffei M.D.
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Editor information

Editors and Affiliations

  1. Children's Heart Group, Div. Pediatric Critical Care, Penn State Children's Hospital, University Drive 500, Hershey, 17078, Pennsylvania, USA

    Steven E. Lucking

  2. Janet Weis Children's Hospital @ Geising, Pediatric Critical Care Medicine, Temple University School of Medicine, N. Academy Ave 100, Danville, 17822, Pennsylvania, USA

    Frank A. Maffei

  3. Milton S. Hershey Medical Center, Penn State College of Medicine, University Drive 500, Hershey, 17033-2390, Pennsylvania, USA

    Robert F. Tamburro

  4. College of Medicine, Penn State Children's Hospital, Pennsylvania State University, University Drive 500, Hershey, 17078, Pennsylvania, USA

    Neal J. Thomas

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© 2012 Springer-Verlag London Limited

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Lambert, R.L., Brink, L.W., Maffei, F.A. (2012). Sedation and Analgesia. In: Lucking, S., Maffei, F., Tamburro, R., Thomas, N. (eds) Pediatric Critical Care Study Guide. Springer, London. https://doi.org/10.1007/978-0-85729-923-9_18

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  • DOI: https://doi.org/10.1007/978-0-85729-923-9_18

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  • Publisher Name: Springer, London

  • Print ISBN: 978-0-85729-922-2

  • Online ISBN: 978-0-85729-923-9

  • eBook Packages: MedicineMedicine (R0)

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