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Sedation and Analgesia

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Critical Care of Children with Heart Disease

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Abstract

Management of sedation and analgesia in the pediatric patient after cardiac surgery and cardiopulmonary bypass is of particular importance in the setting of decreased cardiac function and increased metabolic oxygen demands secondary to inflammatory responses. Important considerations include the relief of pain and anxiety, attenuation of the stress response, and maintaining mechanical ventilation synchrony. Opioid and benzodiazepine medications have historically been the mainstay sedative and analgesic agents in the intensive care unit, and they do indeed still have an important role. Still, other agents, such as dexmedetomidine, ketamine, propofol, and neuromuscular blockers, will help to provide a more balanced and tailored sedative and analgesic plan in order to maintain a level of non-agitation and hemodynamic stability in a wide variety of pediatric patients with specific needs. Additionally, many pediatric patients with congenital cardiac disease will require extracorporeal membrane oxygenation, which presents many pharmacokinetic implications that will significantly alter the pharmacodynamic effects of some of these drugs. Thus, the understanding of these alterations and the ability to adapt the patient’s sedative and analgesic plan to account for them is a necessity.

Steven E. Litchenstein is deceased at the time of publication of this chapter.

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Authors and Affiliations

  1. Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Garrett Roney, Patrick M. Callahan, Peter J. Davis & Phillip S. Adams

  2. Department of Anesthesiology, Duke University School of Medicine, Durham, NC, USA

    Edmund H. Jooste

  3. Department of Anesthesiology, Nemours Children’s Hospital, Orlando, FL, USA

    Steven E. Litchenstein

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  1. Garrett Roney
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  2. Edmund H. Jooste
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  3. Patrick M. Callahan
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  4. Steven E. Litchenstein
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  5. Peter J. Davis
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  6. Phillip S. Adams
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Correspondence to Phillip S. Adams .

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Editors and Affiliations

  1. Chief, Division of Cardiac Critical Care Medicine Executive Director, Telemedicine Co-director, Children’s National Heart Institute, Professor of Pediatrics, George Washington University School of Medicine, Children’s National Health System, Washington, DC, USA

    Ricardo A. Munoz

  2. Department of Pediatric Cardiothoracic Surgery, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA

    Victor O. Morell

  3. Associate Medical Director, CHCO Heart Institute Head, Pediatric Cardiac Critical Care Program & Inpatient Services Director, Cardiac Intensive Care Unit Children’s Hospital Colorado, Tenured Professor of Pediatrics, Pediatric Cardiology and Intensive Care University of Colorado Denver, School of Medicine, Aurora, CO, USA

    Eduardo M. da Cruz

  4. Department of Pharmacy, Pediatric Critical Care, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA

    Carol G. Vetterly

  5. Department of Pediatric Cardiothoracic Surgery, UPMC – Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA

    Jose Pedro da Silva

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Roney, G., Jooste, E.H., Callahan, P.M., Litchenstein, S.E., Davis, P.J., Adams, P.S. (2020). Sedation and Analgesia. In: Munoz, R., Morell, V., da Cruz, E., Vetterly, C., da Silva, J. (eds) Critical Care of Children with Heart Disease . Springer, Cham. https://doi.org/10.1007/978-3-030-21870-6_9

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  • DOI: https://doi.org/10.1007/978-3-030-21870-6_9

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