Pharmacological sedation management in the paediatric intensive care unit

Baarslag, Manuel A.; Allegaert, Karel; Knibbe, Catherijne; Dijk, Monique van; Tibboel, Dick

doi:10.1111/jphp.12630

Cited by 22 publications

(50 citation statements)

References 159 publications

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“…Initially, anxiety should be allayed with attempts to normalize the child’s surroundings with non-pharmacologic interventions. Communication, continuous reorientation, reassurance, and the presence of relatives at the bedside can allay anxiety, while environmental factors such as noise reduction, utilization of adequately lighting to promote an adequate sleep awake cycle, promoting time to rest and sleep to maintain a circadian orientation, restricting procedures to daytime, keeping the patient in a comfortable position using cushions, and attention to fluids and feeding may improve comfort [ 16 – 18 ]. Non-pharmacologic interventions to reduce stress, such as live or recorded music, have primarily been studied in adults, but make sense for children as well [ 16 ].…”

Section: Reviewmentioning

confidence: 99%

“…Communication, continuous reorientation, reassurance, and the presence of relatives at the bedside can allay anxiety, while environmental factors such as noise reduction, utilization of adequately lighting to promote an adequate sleep awake cycle, promoting time to rest and sleep to maintain a circadian orientation, restricting procedures to daytime, keeping the patient in a comfortable position using cushions, and attention to fluids and feeding may improve comfort [ 16 – 18 ]. Non-pharmacologic interventions to reduce stress, such as live or recorded music, have primarily been studied in adults, but make sense for children as well [ 16 ]. Use of earplugs, eye masks, noise reduction, and darkness for sleep promotion is uncommon in critical care settings; however, efforts to normalize the patient’s routine may allow the child to feel more secure and less anxious [ 5 ].…”

Section: Reviewmentioning

confidence: 99%

“…Light and noise, for example, can be disturbing. Allowing children to wear ear plugs, asking staff to speak softly, and preventing ongoing alarm sounds can be helpful [ 16 ]. Environmental noise in critical care units ranges from 60 to 84 dB, with the World Health Organization defining 55 dB as serious annoyance [ 17 ].…”

Section: Reviewmentioning

confidence: 99%

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Considerations for pediatric burn sedation and analgesia

Fagin

Palmieri

2017

Burns &Amp; Trauma

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Burn patients experience anxiety and pain in the course of their injury, treatment, and recovery. Hence, treatment of anxiety and pain is paramount after burn injury. Children, in particular, pose challenges in anxiety and pain management due to their unique physiologic, psychologic, and anatomic status. Burn injuries further complicate pain management and sedation as such injuries can have effects on medication response and elimination. Burn injuries further complicate pain management and sedation as such injuries can have effects on medication response and elimination. The purpose of this review is to describe the challenges associated with management of anxiety, pain, and sedation in burned children and to describe the different options for treatment of anxiety and pain in burned children.

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Section: Reviewmentioning

confidence: 99%

Section: Reviewmentioning

confidence: 99%

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Considerations for pediatric burn sedation and analgesia

Fagin

Palmieri

2017

Burns &Amp; Trauma

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“…Clonidine acts as an alpha2‐adrenoceptor agonist and is approved for the treatment of hypertension, as an adjunct for epidural pain management, and for the management of pediatric attention deficit hyperactivity disorder. Clonidine is used off‐label in pediatric anesthesia for several indications, for example, treatment of acute pain, sedation in intensive care, treatment and prevention of postoperative agitation and to counter withdrawal symptoms in children after long‐term sedation 1‐5 . Pharmacokinetic knowledge is helpful for optimal clinical use, and clonidine pharmacokinetics in children has been investigated for oral, 6 intranasal, 7 rectal, 8 epidural, 9,10 and intravenous administration 11‐13 .…”

Section: Introductionmentioning

confidence: 99%

Pharmacokinetics of an intravenous bolus dose of clonidine in children undergoing surgery

Nielsen

Anderson

Falcon

et al. 2020

Pediatric Anesthesia

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Background Clonidine is used off‐label in children but only limited pediatric pharmacokinetic data are available for intravenously administered clonidine. Objectives To determine pharmacokinetic parameter estimates of clonidine in healthy children undergoing surgery and to investigate age‐related differences. Furthermore, to investigate possible pharmacokinetic differences of clonidine between this group of children and a cohort with cardiac diseases. Methods In a randomized placebo‐controlled trial (The PREVENT AGITATION trial), blood samples for clonidine pharmacokinetic analysis were collected in a proportion of the enrolled patients. Healthy children with ASA score 1‐2 in the age‐groups 1 to <2 years and 2‐5 years were randomized for blood sampling. Clonidine was administered as a single intravenous bolus of 3 µg/kg intraoperatively. Blood samples were drawn at baseline, 5, 10, 15, 30, 60 minutes after dosing and additionally every hour until discharge from the PACU. Clonidine analysis was performed on liquid chromatography‐mass spectrometry. Results Data form eighteen children were available for pharmacokinetic analysis (ASA I; male/female: 17/1; age: 1‐5 years; weight 8.7‐24 kg). Population parameter estimates for the 2‐compartment model were similar to previous published data for children who underwent cardiac surgery. A pooled analysis including data from 59 children indicated clearance of 14.4 L h−1 70 kg−1 and volume of distribution of 192.6 L 70 kg−1. No age‐related pharmacokinetic differences and no difference in time from administration of study medication to awakening were found. Children 1 to <2 years had a shorter PACU stay than children 2‐5 years (mean difference 17% 95% CI:3%‐34%, P = .02). Conclusion Pharmacokinetic parameter estimates were similar for children undergoing general surgery and cardiac surgery given a single dose of intravenous clonidine. These results indicated that no dose reduction is needed in children aged 1 to <2 years compared with those 2‐5 years, which was supported by pharmacodynamic observations.

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“…Dexmedetomidine also has only minimal effects on respiration [7][8]. Due to its many beneficial properties, dexmedetomidine is currently quite commonly employed in off-label use in pediatric intensive care [9]. In addition, dexmedetomidine has been used in children for other purposes, such as MRI sedation, and several previous reports describe its use in ambulatory sedation of pediatric patients [10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Premedication with intranasal dexmedetomidine decreases barbiturate requirement in pediatric patients sedated for magnetic resonance imaging: a retrospective study

Uusalo

Lehtinen

Löyttyniemi

et al. 2019

Preprint

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Background: Barbiturates are commonly used in ambulatory sedation of pediatric patients. However, use of barbiturates involve risks of respiratory complications. Dexmedetomidine, a highly selective α2-adrenoceptor agonist, is increasingly used for pediatric sedation. Premedication with intranasal (IN) dexmedetomidine offers a non-invasive and efficient possibility to sedate pediatric patients undergoing magnetic resonance imaging (MRI). Our hypothesis was that dexmedetomidine would reduce barbiturate requirements in procedural sedation. Methods: We included 200 consecutive pediatric patients undergoing MRI, and analyzed their hospital records retrospectively. Half of the patients received 3 μg/kg of IN dexmedetomidine (DEX group) 45-60 min before MRI while the rest received only thiopental (THIO group) for procedural sedation. Sedation was maintained with further intravenous thiopental dosing as needed. Thiopental consumption, heart rate (HR) and peripheral oxygen saturation were recorded. Results: The cumulative thiopental requirement during MRI was (median and interquartile range [IQR]) 4.4 (2.7-6.0) mg/kg/h in the DEX group and 12.4 (9.8-14.8) mg/kg/h in the THIO group (difference 7.9 mg/kg/h, 95% CI 6.8–8.8, P < 0.001). Lowest measured peripheral oxygen saturation remained slightly higher in the DEX group compared to the THIO group (median nadirs and IQR: 97 (95-97) % and 96 (94-97) %, P < 0.001). Supplemental oxygen was delivered to 33 % of the patients in the THIO group compared to 2 % in the DEX group (P < 0.001). The lowest measured HR (mean and SD) was lower (78 (16) bpm) in the DEX group compared to the THIO group (92 (12) bpm) (P < 0.001). Conclusion: Premedication with IN dexmedetomidine (3 μg/kg) was associated with markedly reduced thiopental dosage needed for efficient procedural sedation for pediatric MRI.

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Pharmacological sedation management in the paediatric intensive care unit

Cited by 22 publications

References 159 publications

Considerations for pediatric burn sedation and analgesia

Considerations for pediatric burn sedation and analgesia

Pharmacokinetics of an intravenous bolus dose of clonidine in children undergoing surgery

Premedication with intranasal dexmedetomidine decreases barbiturate requirement in pediatric patients sedated for magnetic resonance imaging: a retrospective study

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