Sedation and analgesia in critically ill children

Effective analgesia and sedation in the Paediatric Intensive Care Unit (PICU) encompasses the provision of physical comfort and caring for the psychological well-being of critically ill children. In the UK the most commonly used sedative and analgesic agents for critically ill children are midazolam and morphine; 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.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 emerging concerns that sedative and analgesic agents may themselves be associated with developmental neurotoxicity, particularly amongst neonates.The extent and impact of psychological morbidity associated with the use of sedative and analgesic agents are poorly understood. Withdrawal syndrome and delirium probably represent part of a spectrum of adverse psychological effects. There appears to be considerable overlap in the features of psychological morbidity contributed to by pharmacological agents, and other disease states encountered in the critically ill. The most important single factor in reducing avoidable psychological morbidity in survivors of PICU is to minimize the administered doses of sedative and analgesic agents.