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Sedation and Analgesia in ICU Paediatric Patients

  • D. A. Rosen
  • K. R. Rosen
Conference paper

Abstract

Total comfort for the child is a goal that should be part of every admission to the paediatric intensive care unit. It is no longer acceptable to focus our attention only on the acute aspects of the disease process which has resulted in the PICU admission while ignoring all others. In the past comfort issues have rarely been addressed unless they directly impacted on management, but now the interrelationship between comfort and outcome have begun to surface. Total comfort for the child must be approached differently than the adult because of differences which exist in pharmacology of the medications used, neurological maturation, and cognitive development which occur as the paediatric patient matures. Total comfort is directed towards pain management. The pain which needs to be addressed is the physical pain resulting from trauma, surgery or the disease process as well as the psychological pain which results from the strange environment and the need to lay still in bed while the physical problems are being dealt with.

Keywords

Epidural Space Retrograde Amnesia Sedative Agent Sedative Medication Paradoxical Reaction 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Frank RS, Boltz MG, Sentivany SK et al (1995) Combined epidural general anesthesia for the repair of atrial septal defects in children results in shorter ICU stays. Anesthesiology 83: A1176CrossRefGoogle Scholar
  2. 2.
    Tholl DA, Wager MS, Sajous CH et al (1994) Morphine use and adverse effects in a neonatal intensive care unit. Am J Hosp Pharm 51: 2801–2803PubMedGoogle Scholar
  3. 3.
    Morton NS (1997) Pain assessment in children. Paediatr Anesth 7: 267–272CrossRefGoogle Scholar
  4. 4.
    Krechel SW, Bildner J (1995) CRIES: a new neonatal postoperative pain measurement score. Initial testing of validity and reliability. Paediatr Anaesth 5: 53–61PubMedCrossRefGoogle Scholar
  5. 5.
    Beyer JE, Wells N (1989) The assessment of pain in children. Pediatr Clin N Am 36: 837–853Google Scholar
  6. 6.
    Broadman LM, Rice LH, Hannalla RS (1988) Testing the validity of an objective pain scale for infants and children. Anesthesiology 69: A770CrossRefGoogle Scholar
  7. 7.
    Barrier G, Attia J, Mayer MN et al (1989) Measurement of postoperative pain and narcotic administration in infants using a new clinical scoring system. Intens Care Med 15: S37–S39Google Scholar
  8. 8.
    Rosen DA, Rosen KR, Bhatt-Mehta V (1991) Clinical approaches to sedation in the pediatric intensive care unit. In: Reves JG (ed) Anesthesia and sedation by continuous infusion. Excerpta Medica, Elsevier, Princeton NJ 89–96Google Scholar
  9. 9.
    Flandin-Blety C, Barrrier G (1995) Accidents following extradural analgesia in children: the results of a retrospective study. Pediatr Anesth 5: 41–26CrossRefGoogle Scholar
  10. 10.
    Bosenberg AT (1995) Skin: epidural distance in children. Anesthesia 50: 895–897CrossRefGoogle Scholar
  11. 11.
    Twersky RS, Hartrung J, Berger BJ et al (1993) Midazolam enhances antegrade but not retrograde amnesia in pediatric patients. Anesthesiology 78: 51–55PubMedCrossRefGoogle Scholar
  12. 12.
    Koht A, Moss JI (1997) Does midazolam cause retrograde amnesia, and can flumazenil reverse that amnesia. Anesth Analg 85: 211–212PubMedGoogle Scholar
  13. 13.
    Hertle I, Scheller M, Butler J et al (1997) Interaction of midazolam with the nicotinic acetylcholine receptor of the mouse myotubes. Anesth Analg 85: 174–181PubMedGoogle Scholar
  14. 14.
    Khan LC, Lustik SJ (1997) Treatment of a paradoxical reaction to midazolam with haloperidol. Anesth Anal 85: 213–215Google Scholar
  15. 15.
    Kissin I, Lee SS, Arthur G et al (1997) Effects of midazolam on development of acute tolerance to alfentanil: the role of pharmacokinetic interaction. Anesth Anal 85: 182–187Google Scholar

Copyright information

© Springer-Verlag Italia, Milano 1998

Authors and Affiliations

  • D. A. Rosen
  • K. R. Rosen

There are no affiliations available

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