Sedation in the paediatric intensive care unit

Abstract

Sedation in the paediatric patient receiving intensive care broadly involves the provision of pharmacological agents to minimise the response to an unfamiliar environment. Analgesia, though sometimes produced by the same agents, should always be separately and specifically considered, as indeed should formal anaesthesia for painful procedures and operative surgery. It is likely that children have very different psychological responses to the intensive care environment dependent upon both their age and developmental level as well as previous experience. In general the need for sedation is greater in paediatric patients than in adults and this would seem to be particularly so in the preschool child. The goals of sedation in paediatric intensive care are elaborated in Table l , With regard to the provision of drugs to prevent the patient 'fighting' the ventilator, heavy sedation (sometimes combined with paralysis) is still occasionally used. However paralysis will not necessarily reduce overall ventilatory requirements and may result in changes in ventilation and perfusion which result in a worsening of blood gases. New modes of ventilation such as synchronised IMV and patient triggered ventilation have provided improved patient comfort and reduced sedative requirements. Muscle relaxants are seldom required. The use of sedative agents should always be in conjunction with non-pharmacological means of creating a 'child friendly' intensive care environment (Table 2). In certain circumstances even intubated children may be successfully managed without specific sedative agents. 1 This management is only successful if non-pharmacological measures are in place. However, sedative agents are usually considered routinely in paediatric intensive care practice. No agent is without side-effects (see Table 3) but problems can often be avoided by careful administration, regular assessment and dose modification. The most important factor to be aware of when using sedatives in intensive care are circumstances which lead