SEDATION AND ANALGESIA IN INTENSIVE CARE

Sedation is frequently needed in PICUs to provide analgesia, control unwanted motions and reduce the anxiety related to either primary disease or various procedures and interventions.

TABLE 27.17: Common drugs for sedation and analgesia

*Or continuous IV infusion 0.5 #956;g#8725;kg#8725;hr

TABLE 27.18: PRISM scoring

Vital signs

• Systolic BP

• Heart rate

• Stupor/coma (GCS lt;8)

• Pupillary reflexes

Acid-base status

• PH lt;7.28 or gt; 7.48

• Total CO₂ gt;34 mmol/L

• PaO₂ lt;50 mm Hg

• PaCO₂ gt;50 mm Hg

Blood chemistry

• Blood sugar (gt;200 mg/dl)

• S. potassium (gt;6.9 mmol/L)

• Elevated S.

• Elevated blood urea

Hematology

• TLC lt; 3000 cells/mm³

• Platelet count lt;50,000/mm³

• PT (gt;22 sec)/PTT (gt;57 sec)

Others:

• Non-operative illness

• Chromosomal anomaly

• Cancer

• Previous PICU admission

• Pre-ICU resuscitation

• Post-operative stage

• Diabetes (Ketoacidosis)

• Transfer from inpatient unit

GCS: Glasgow coma scale

Sedation is frequently required to:

• To avoid sudden movements and minimize anxiety during various non-invasive procedures, e.g.

• To minimize anxiety and pain during common procedures, e.g. intravenous cannulations and blood collections.

• To minimize substantial pain associated with invasive procedures, e.g. biopsies, tappings, aspiration cytoญlogies and abscess drainage procedures.

• To avoid unexpected respiratory movements in a ventilated child

However, the depth and duration of sedation has to be appropriate to the needs and should not compromise vital functions. Table 27.17) provides commonly used drugs for sedation and analgesia in children, some of which can be given as continuous infusions till needed.

27.4.7