Use of analgesic and sedative drugs in the NICU: integrating clinical trials and laboratory data.
Recent advances in neonatal intensive care include and are partly attributable to growing attention for comfort and pain control in the term and preterm infant requiring intensive care.Limitation of painful procedures is certainly possible, but most critically ill infants require unavoidable painful or stressful procedures such as intubation, mechanical ventilation, or catheterization.Many analgesics (opioids and nonsteroidal anti-inflammatory drugs)and sedatives (benzodiazepines and other anesthetic agents) are available but their use varies considerably among units. This review summarizes current experimental knowledge on the effects of sedative and analgesic drugs on brain development and reviews clinical evidence that speaks for or against the use of common analgesic and sedative drugs in the NICU but avoids any discussion of anesthesia during surgery. Risk/benefit ratios of intermittent boluses or continuous infusions for the commonly used sedative and analgesic agents are discussed in the light of clinical and experimental studies. The limitations of extrapolating experimental results from animals to humans must be considered while making practical recommendations based on the currently available evidence.
Durrmeyer
Xavier
X
Neonatal Intensive Care Unit, Centre Hospitalier Intercommunal de Créteil, Créteil 94000, France.
Vutskits
Laszlo
L
Anand
Kanwaljeet J S
KJ
Rimensberger
Peter C
PC
D000698:Analgesia / Q000009:adverse effects; D000700:Analgesics / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000818:Animals; D001921:Brain / Q000187:drug effects / Q000254:growth & development; D002986:Clinical Trials as Topic; D019317:Evidence-Based Medicine; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D007231:Infant, Newborn; D007263:Infusions, Parenteral; D007267:Injections; D007363:Intensive Care Units, Neonatal; D015931:Intensive Care, Neonatal / Q000379:methods*; D007442:Intubation, Intratracheal; D020258:Neurotoxicity Syndromes / Q000209:etiology / Q000503:physiopathology; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D012121:Respiration, Artificial; D018570:Risk Assessment
D000700:Analgesics; D006993:Hypnotics and Sedatives