title: Assessment of pain in critically ill children. Is cutaneous conductance a reliable tool?
abstract: OBJECTIVE
  The purpose of this study is to assess the usefulness and accuracy of skin conductance (SC) as a tool to evaluate the level of sedation and pain in pediatric critical patients during painful procedures and to compare it with hemodynamic variables, clinical scales, and bispectral index (BIS).
  
  
  METHODS
  This is a prospective observational study in 61 critical children undergoing invasive procedures. Hemodynamic data (heart rate and arterial blood pressure), clinical scales punctuation (Ramsay, COMFORT, and numeric rating pain scales), BIS, and the number of fluctuations of SC per second were collected before, during, and at the end of the procedure.
  
  
  RESULTS
  The mean age of the patients was 42.9 (range, 1 month to 16 years). Seventy-two point six percent were postcardiac surgery patients. Nonmuscle-relaxed patients showed a moderate increase in heart rate (P = .02), numeric rating pain scales (P = .03), and Ramsay scale (P = .002). The number of fluctuations of SC per second increased significantly during the procedure (basal, 0.1; maneuver, 0.2; P = .015), but it never reached the level considered as pain or stress nor did it precede clinical scales or BIS. None of the variables studied showed a significant change during the procedure in muscle-relaxed patients.
  
  
  CONCLUSIONS
  Skin conductance was not found to be more sensitive or faster than clinical scales for the assessment of pain or stress in critical children undergoing painful procedures. Skin conductance was not useful in muscle-relaxed children.
authors.affiliation: Pediatric Intensive Care Service, Hospital General Universitario Gregorio Marañón, Dr Castelo 47, 28009 Madrid, Spain; Instituto de Investigación del Hospital Gregorio Marañón, Doctor Esquerdo 46, 28009 Madrid, Spain. Electronic address: mjsolana@hotmail.com.
authors.forename: M J
authors.initials: MJ
authors.lastname: Solana
authors.affiliation: Pediatric Intensive Care Service, Hospital General Universitario Gregorio Marañón, Dr Castelo 47, 28009 Madrid, Spain; Instituto de Investigación del Hospital Gregorio Marañón, Doctor Esquerdo 46, 28009 Madrid, Spain. Electronic address: pielvi@hotmail.com.
authors.forename: J
authors.initials: J
authors.lastname: Lopez-Herce
authors.affiliation: Pediatric Intensive Care Service, Hospital General Universitario Gregorio Marañón, Dr Castelo 47, 28009 Madrid, Spain; Instituto de Investigación del Hospital Gregorio Marañón, Doctor Esquerdo 46, 28009 Madrid, Spain. Electronic address: sarahlafever@gmail.com.
authors.forename: S
authors.initials: S
authors.lastname: Fernandez
authors.affiliation: Pediatric Intensive Care Service, Hospital General Universitario Gregorio Marañón, Dr Castelo 47, 28009 Madrid, Spain; Instituto de Investigación del Hospital Gregorio Marañón, Doctor Esquerdo 46, 28009 Madrid, Spain. Electronic address: rafagonzalezcortes@hotmail.com.
authors.forename: R
authors.initials: R
authors.lastname: Gonzalez
authors.affiliation: Pediatric Intensive Care Service, Hospital General Universitario Gregorio Marañón, Dr Castelo 47, 28009 Madrid, Spain; Instituto de Investigación del Hospital Gregorio Marañón, Doctor Esquerdo 46, 28009 Madrid, Spain. Electronic address: pazienziainfinita@yahoo.es.
authors.forename: J
authors.initials: J
authors.lastname: Urbano
authors.affiliation: Pediatric Intensive Care Service, Hospital General Universitario Gregorio Marañón, Dr Castelo 47, 28009 Madrid, Spain; Instituto de Investigación del Hospital Gregorio Marañón, Doctor Esquerdo 46, 28009 Madrid, Spain. Electronic address: dr_pyta@yahoo.es.
authors.forename: J
authors.initials: J
authors.lastname: Lopez
authors.affiliation: Instituto de Investigación del Hospital Gregorio Marañón, Doctor Esquerdo 46, 28009 Madrid, Spain. Electronic address: bellon.hgugm@salud.madrid.org.
authors.forename: J M
authors.initials: JM
authors.lastname: Bellon
mesh_terms: D000293:Adolescent; D000698:Analgesia; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation; D016638:Critical Illness; D005260:Female; D005712:Galvanic Skin Response / Q000502:physiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010147:Pain Measurement; D011446:Prospective Studies
keywords: Children; Critical care; Monitoring; Pain; Sedation; Skin conductance