Sedation, analgesia, and neuromuscular blockade during pediatric mechanical ventilation.
The mechanically ventilated PICU patient is subjected to multiple noxious stimuli ranging from a bright, noisy, and intimidating environment to painful but necessary procedures. His or her primary disease process or processes obviously constitutes another potential source of noxious stimuli as well. As a result, these patients almost certainly need some combination of medications to allay anxiety, treat discomfort, and perhaps otherwise optimize medical management. Intensivists now have at hand an impressive array of medications that can be used to blunt the stresses imposed by these stimuli. Sedatives to induce anxiolysis and calmness, analgesics to alleviate pain, and occasionally neuromuscular blocking agents to inhibit movement may be used. Use of these medications can be tailored to meet the varied requirements of the diverse PICU population. The consequences of incorrect use can be sobering. Familiarity with the pharmacology, indications, and side effects of the individual medications is a necessity for all ICU care providers to prevent misuse. Although the frequent need for analgesics, sedatives, and NMBDs in the PICU is undisputed, the development of reliable methods for accurately assessing the degree of patient sedation or analgesia will greatly facilitate efforts to improve patient care Appropriate use of sedatives, analgesics, and NMBDs provides an invaluable service. It is important to remember, however, that even in the high-technology PICU environment verbal and physical reassurance remains a powerful tool for providing comfort and anxiolysis to critically ill children. There is no pharmacologic equivalent of human compassion.
Movius
A J
AJ
Department of Anesthesiology, University of Washington School of Medicine, Seattle, Washington, USA.
Martin
L D
LD
D000293:Adolescent; D000698:Analgesia / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000494:pharmacology; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008991:Monitoring, Physiologic; D009466:Neuromuscular Blocking Agents / Q000009:adverse effects / Q000494:pharmacology; D009469:Neuromuscular Junction / Q000187:drug effects / Q000502:physiology; D012121:Respiration, Artificial
D006993:Hypnotics and Sedatives; D009466:Neuromuscular Blocking Agents