When compared with a similar survey from 1989, this survey suggests that pediatric critical care units with fellowship training programs have made some changes in their approach to sedation and analgesia over the past decade. More fellowship directors report the use of sedation protocols and better recognition, prevention, and management of drug withdrawal. Similar analgesic, sedative, and neuromuscular blocking drugs are being used but some more commonly than a decade ago.

No abstract

Background Emergence agitation (EA) and negative postoperative behavioral changes (NPOBC) are common in children, though the etiology remains unclear. We investigated whether longer times under deep hypnosis as measured by Bispectral Index™ (BIS) monitoring would positively correlate with a greater incidence of EA in the post anesthesia care unit (PACU) and a greater occurrence of NPOBC in children after discharge. Methods We enrolled 400 children, ages 1–12 years old, scheduled for dental procedures under general anesthesia. All children were induced with high concentration sevoflurane and BIS monitoring was continuous from induction through recovery in the PACU. A BIS reading <45 was considered deep hypnosis. The presence of EA was assessed in the PACU using the Pediatric Anesthesia Emergence Delirium Scale (PAED). NPOBC were assessed using the Post-Hospital Behavior Questionnaire (PHBQ), completed by parents 3–5 days post-operatively. Data were analyzed using logistic regression, with a p<0.05 considered statistically significant. Results The incidence of EA was 27% (99/369) and the incidence of NPOBC was 8.8% (28/318). No significant differences in the incidence of EA or NPOBC were seen with respect to length of time under deep hypnosis as measured by a BIS value of less than 45. Conclusion Our data revealed no significant correlation between the length of time under deep hypnosis (BIS<45) and the incidence of EA or NPOBC. Within this population, these behavioral disturbances do not appear to be related to the length of time under a deep hypnotic state as measured by the BIS.

No abstract