Sedation and analgesia for critically ill children

Effective sedation and analgesia in the critically ill child ensures physical comfort and minimises psychological distress. In the UK the most commonly used sedative and analgesic agents for critically ill children are midazolam and either morphine or fentanyl. Consensus clinical practice guidelines for the provision of sedation and analgesia in critically ill children were published in 2006 by the UK Paediatric Intensive Care Society, but considerable variation in practice persists.It is important to treat pain, and in addition to the obvious immediate effects of untreated pain there is increasing evidence that pain experienced early in life may result in long-term changes in neurosensory function. There are however also concerns that sedative and analgesic agents may themselves be associated with developmental neurotoxicity, particularly amongst neonates, and adverse psychological outcomes in survivors of critical care.Withdrawal syndrome and delirium remain poorly understood, although we have emerging tools such as the Sophia Observation withdrawal Symptoms-scale (SOS) and the paediatric Confusion Assessment Method for the ICU (pCAM-ICU). The most important single factor in reducing avoidable psychological morbidity in survivors of PICU is to minimise the administered doses of sedative and analgesic agents.