A Practical Guide to Sedation and Analgesia in Paediatric Intensive Care Unit (ICU)

All critically ill children have the right to adequate relief of their pain Correctable physical and environmental factors causing discomfort should be addressed using non-pharmacologic interventions before the initiation of pharmacologic interventions. The choice of sedative-analgesic agent and its initial dose are selected on the basis of several factors such as cause of the distress, desire depth and duration of therapy, clinical condition, potential drug interactions and pharmacokinetic modifying variables. Analgosedation: prioritize the use of analgesia first and then sedation should be the norm while starting sedative-analgesic and reverse to be followed in the weaning process. The level of sedation should be regularly assessed and documented using a sedation assessment scale, wherever possible using a validated scoring system such as the COMFORT scale Once the primary cause of ICU admission is treated, the sedative requirement should fall. Attempt should be made to reduce the level of sedation which require an individualised approach based on clinical condition, drug used for sedation-analgesia, total dose and duration of therapy. During reduction or withdrawal of sedative-analgesic, children should be closely observed for development of withdrawal symptoms. *Corresponding author: Dr. Surjya Prasad Upadhyay, Specialist Anaesthesiology, NMC Hospital Dubai, Investment Park, Dubai, UAE, E-mail: [email protected] Citation: Upadhyay, S.P., et al. A Practical Guide to Sedation and Analgesia in Paediatric Intensive Care Unit (ICU). (2017) J Anesth Surg 4(1): 16. A Practical Guide to Sedation and Analgesia in Paediatric Intensive Care Unit (ICU) Surjya Prasad Upadhyay1*, Anand Tripathy1, Sameer kapoor2, Piyush N Mallick3 Received date: December 26, 2016 Accepted date: January 10, 2017 Published date: January 16, 2017 DOI: 10.15436/2377-1364.17.061 Upadhyay, S.P., et al. ed need for sedation without proper monitoring and frequent re-evaluation that may contribute to adverse outcomes and complications[5]. Both under-sedation and over sedation have the potential to lead to agitated patients with compromised short-term safety issues and impact on duration of ventilation and length of stay (LOS)[6,7]. Contrary to earlier belief that as long as they were properly sedated, children in ICU were unaware of what was happening to them; new evidences are emerging that they, like adults, children can suffer from disturbing memories of their ICU course, which can affect their longer-term psychological recovery. The consequences of both under sedation and over-sedation are potentially amplified in the critically ill child in the paediatric ICU due to the developing brain[8].