Book contents
- Intensive Care Medicine
- Intensive Care Medicine
- Copyright page
- Dedication
- Dedication
- Epigraph
- Contents
- Contributors
- Preface
- Foreword
- Abbreviations
- Section 1 Resuscitation and Management of the Acutely Ill Patient
- Section 2 Diagnosis, Assessment, Investigation, Monitoring and Data Interpretation
- Domain 3 Disease Management: Recognition, Causes and Management
- Section 4 Therapeutic Interventions and Organ Support
- Domain 5 Practical Procedures
- Section 6 Perioperative Care
- Section 7 Comfort and Recovery
- Section 8 End-of-Life Care
- Section 9 Paediatric Care
- Introduction
- Differences
- Clinical Assessment
- Introduction
- Scoring Systems and Quality Metrics in PICU
- Paediatric Intensive Care Transport Services
- Changing Patterns of PICU
- Relevance to the Intensivist
- How Widespread Is Child Abuse?
- Types of Abuse
- The Safeguarding Process – Roles, Responsibilities and Processes
- Respiratory Anatomy and Physiology in Children
- Upper Airway Obstruction
- Intubating the Child with Upper Airway Obstruction
- Paediatric Acute Respiratory Distress Syndrome
- Diseases of the Lower Airway
- High-Flow Nasal Cannulae
- Continuous Positive Airway Pressure
- Mechanical Ventilation
- High-Frequency Oscillatory Ventilation
- Extracorporeal Membrane Oxygenation
- Definition and Recognition of Sepsis
- Patterns of Sepsis Presentation
- Haemodynamics of Paediatric Septic Shock
- Protocolised Management of Sepsis
- Current Controversies
- Outcomes in Sepsis and Septic Shock
- Introduction
- Status Epilepticus
- Coma
- Neurosurgical Emergencies
- Introduction
- Initial Management
- Sudden Unexpected Death in Infancy and Sudden Infant Death Syndrome
- Introduction
- Presentation in Infancy
- Diagnosis and Management of Infants with Suspected Congenital Heart Disease
- Norwood Stage 1, Glenn or Fontan
- Acute Presentations
- Introduction
- The Primary Survey
- Head Injury
- Cervical Spine Injury
- Introduction
- Acute Liver Failure
- Inborn Errors of Metabolism
- Diabetic Ketoacidosis
- Introduction
- Analgesic Agents
- Sedative Agents
- 9.1 Assessment and Management of the Sick Child
- 9.2 Organisation of Paediatric Intensive Care and Paediatric Intensive Care Transport Services in the UK
- 9.3 Safeguarding and Non-accidental Injury
- 9.4 Respiratory Failure
- 9.5 Paediatric Sepsis
- 9.6 Acute Neurological Disorders
- 9.7 The Collapsed Infant
- 9.8 Congenital Heart Disease
- 9.9 Trauma
- 9.10 Acute Liver Failure, Inborn Errors of Metabolism and Diabetic Ketoacidosis
- 9.11 Analgesia and Sedation in the Paediatric Intensive Care Unit
- Section 10 Transport
- Section 11 Professionalism, Patient Safety, Governance and Health Systems Management
- Index
- References
9.11 - Analgesia and Sedation in the Paediatric Intensive Care Unit
from Section 9 - Paediatric Care
Published online by Cambridge University Press: 27 July 2023
Book contents
- Intensive Care Medicine
- Intensive Care Medicine
- Copyright page
- Dedication
- Dedication
- Epigraph
- Contents
- Contributors
- Preface
- Foreword
- Abbreviations
- Section 1 Resuscitation and Management of the Acutely Ill Patient
- Section 2 Diagnosis, Assessment, Investigation, Monitoring and Data Interpretation
- Domain 3 Disease Management: Recognition, Causes and Management
- Section 4 Therapeutic Interventions and Organ Support
- Domain 5 Practical Procedures
- Section 6 Perioperative Care
- Section 7 Comfort and Recovery
- Section 8 End-of-Life Care
- Section 9 Paediatric Care
- Introduction
- Differences
- Clinical Assessment
- Introduction
- Scoring Systems and Quality Metrics in PICU
- Paediatric Intensive Care Transport Services
- Changing Patterns of PICU
- Relevance to the Intensivist
- How Widespread Is Child Abuse?
- Types of Abuse
- The Safeguarding Process – Roles, Responsibilities and Processes
- Respiratory Anatomy and Physiology in Children
- Upper Airway Obstruction
- Intubating the Child with Upper Airway Obstruction
- Paediatric Acute Respiratory Distress Syndrome
- Diseases of the Lower Airway
- High-Flow Nasal Cannulae
- Continuous Positive Airway Pressure
- Mechanical Ventilation
- High-Frequency Oscillatory Ventilation
- Extracorporeal Membrane Oxygenation
- Definition and Recognition of Sepsis
- Patterns of Sepsis Presentation
- Haemodynamics of Paediatric Septic Shock
- Protocolised Management of Sepsis
- Current Controversies
- Outcomes in Sepsis and Septic Shock
- Introduction
- Status Epilepticus
- Coma
- Neurosurgical Emergencies
- Introduction
- Initial Management
- Sudden Unexpected Death in Infancy and Sudden Infant Death Syndrome
- Introduction
- Presentation in Infancy
- Diagnosis and Management of Infants with Suspected Congenital Heart Disease
- Norwood Stage 1, Glenn or Fontan
- Acute Presentations
- Introduction
- The Primary Survey
- Head Injury
- Cervical Spine Injury
- Introduction
- Acute Liver Failure
- Inborn Errors of Metabolism
- Diabetic Ketoacidosis
- Introduction
- Analgesic Agents
- Sedative Agents
- 9.1 Assessment and Management of the Sick Child
- 9.2 Organisation of Paediatric Intensive Care and Paediatric Intensive Care Transport Services in the UK
- 9.3 Safeguarding and Non-accidental Injury
- 9.4 Respiratory Failure
- 9.5 Paediatric Sepsis
- 9.6 Acute Neurological Disorders
- 9.7 The Collapsed Infant
- 9.8 Congenital Heart Disease
- 9.9 Trauma
- 9.10 Acute Liver Failure, Inborn Errors of Metabolism and Diabetic Ketoacidosis
- 9.11 Analgesia and Sedation in the Paediatric Intensive Care Unit
- Section 10 Transport
- Section 11 Professionalism, Patient Safety, Governance and Health Systems Management
- Index
- References
Summary
Key Learning Points
1. There is significant variation in practice in choice of analgesic and sedative agents amongst paediatric intensive care units (PICUs).
2. There are validated pain and sedation scales for assessment of children.
3. Morphine is often used alone for both sedation and analgesia in neonates.
4. Propofol infusions are rarely used for sedation on PICU.
5. An intravenous bolus of ketamine at 1–2 mg/kg is the induction agent of choice for the critically ill, hypotensive child.
Keywords
- Type
- Chapter
- Information
- Intensive Care MedicineThe Essential Guide, pp. 726 - 730Publisher: Cambridge University PressPrint publication year: 2021
References
References and Further Reading
Ambuel, B, Hamlett, KW, Marx, CM, et al. Assessing distress in pediatric intensive care environments: the COMFORT scale. J Pediatr Psychol 1992;17:95–109.Google Scholar
Bellieni, CV, Cordelli, DM, Raffaelli, M, Ricci, B, Morgese, G, Buonocore, G. Analgesic effect of watching TV during venipuncture. Arch Dis Child 2006;91:1015–17.Google Scholar
Hunseler, C, Balling, G, Rohlig, C, et al. Continuous infusion of clonidine in ventilated newborns and infants. Pediatr Crit Care Med 2014;15:511–22.Google Scholar
Jenkins, IA, Playfor, SD, Bevan, C, Davies, G, Wolf, AR. Current United Kingdom sedation practice in pediatric intensive care. Pediatr Anesth 2007;17:675–83.Google Scholar
Playfor, SD. Analgesia and sedation in critically ill children. Contin Educ Anaesth Crit Care Pain 2008;8:90–4.Google Scholar
Saleh, RH. Randomized controlled comparative trial between low dose dexmedetomidine sedation and that of fentanyl in children after surgical procedures in surgical pediatric intensive care unit. Egyptian J Anaesth 2016;32:137–42.Google Scholar
Striker, TW, Stool, S, Downes, JJ. Prolonged nasotracheal intubation in infants and children. Arch Otolaryngol 1967;85:210–13.Google Scholar
Tarbel, SE, Cohen, IT, March, JL. The Toddler-Preschooler Postoperative Pain Scale: an observational scale for measuring post-operative pain in children aged 1–5 years. A preliminary report. Pain 1992;50:273–80.Google Scholar
Wolf, A, McKay, A, Spowart, C, et al. Prospective multicentre randomised, double-blind, equivalence study comparing clonidine and midazolam as intravenous sedative agents in critically ill children: the SLEEPS (Safety profiLe, Efficacy and Equivalence in Paediatric intensive care Sedation) study. Health Technol Assess 2014;18:1–212.CrossRefGoogle ScholarPubMed