Analgesia and sedation in paediatric intensive care

Abstract

Infants and children who are admitted to the intensive care unit (ICU) require treatment for their primary disease and maintenance of their bodily functions (fluid balance, energy intake and temperature control) to optimise recovery. Additional treatments provide analgesia, reduction of the level of consciousness, and when indicated, muscle relaxation. While this triad forms the basis of classical anaesthesia, in paediatric intensive care it is used for longer periods, often below the levels required for surgery and with different goals. This brings to the fore specific problems that relate to the drugs. These include differing pharmacokinetics and drug responses because of age and individual pathophysiology, tolerance and withdrawal, toxicity associated with long-term use and the need to effectively monitor drug effect against delivery. Regrettably, administration of sedative drugs in the paediatric ICU (PICU) is often approached in a generic way and as an afterthought. Instead, more attention is paid to the primary disease. This can lead to morbidity that could have been avoided.