OBJECTIVES: To review the most frequent recommendations, doses and routes of administration of sedatives, analgesics, and muscle relaxants in children, as well as the methods for monitoring the level of sedation. SOURCES: Review of the literature using the MEDLINE database and review of the experience in pediatric intensive care units. SUMMARY OF THE FINDINGS: The continuous administration of analgesics and sedatives prevents the development of undersedation and is less demanding in terms of care than intermittent administration. Midazolam is the most commonly used drug for continuous sedation of critically ill children. Opioid derivatives and nonsteroidal anti-inflammatory drugs are the most widely used analgesics in critically ill children. Opioids combined with benzodiazepines, given in continuous infusion, are the drugs of choice in mechanically ventilated children, especially morphine and fentanyl. The use of protocols and monitoring through clinical scores and objective methods (e.g. bispectral index) allow adjusting medication more appropriately, preventing oversedation, undersedation, and the withdrawal syndrome. Non-pharmacological interventions, such as music therapy, noise control, adequate use of light, massage, conversation with the patient, are ancillary measures that help children to adapt to the adverse hospital environment. CONCLUSIONS: Sedation should be tailored to each child for each specific situation. Protocols that facilitate the correct selection of drugs, their appropriate administration and careful monitoring improve the quality of sedation and analgesia and avoid their adverse effects.
OBJECTIVES: To review the most frequent recommendations, doses and routes of administration of sedatives, analgesics, and muscle relaxants in children, as well as the methods for monitoring the level of sedation. SOURCES: Review of the literature using the MEDLINE database and review of the experience in pediatric intensive care units. SUMMARY OF THE FINDINGS: The continuous administration of analgesics and sedatives prevents the development of undersedation and is less demanding in terms of care than intermittent administration. Midazolam is the most commonly used drug for continuous sedation of critically ill children. Opioid derivatives and nonsteroidal anti-inflammatory drugs are the most widely used analgesics in critically ill children. Opioids combined with benzodiazepines, given in continuous infusion, are the drugs of choice in mechanically ventilated children, especially morphine and fentanyl. The use of protocols and monitoring through clinical scores and objective methods (e.g. bispectral index) allow adjusting medication more appropriately, preventing oversedation, undersedation, and the withdrawal syndrome. Non-pharmacological interventions, such as music therapy, noise control, adequate use of light, massage, conversation with the patient, are ancillary measures that help children to adapt to the adverse hospital environment. CONCLUSIONS: Sedation should be tailored to each child for each specific situation. Protocols that facilitate the correct selection of drugs, their appropriate administration and careful monitoring improve the quality of sedation and analgesia and avoid their adverse effects.
Authors: Cláudia da Costa Silva; Marta Maria Osório Alves; Michel Georges dos Santos El Halal; Sabrina dos Santos Pinheiro; Paulo Roberto Antonacci Carvalho Journal: Rev Bras Ter Intensiva Date: 2013 Oct-Dec