Sedation and Analgesia in Children with Developmental Disabilities and Neurologic Disorders

Abstract

Sedation and analgesia performed by the pediatrician and pediatric subspecialists are becoming increasingly common for diagnostic and therapeutic purposes in children with developmental disabilities and neurologic disorders (autism, epilepsy, stroke, obstructive hydrocephalus, traumatic brain injury, intracranial hemorrhage, and hypoxic-ischemic encephalopathy). The overall objectives of this paper are (1) to provide an overview on recent studies that highlight the increased risk for respiratory complications following sedation and analgesia in children with developmental disabilities and neurologic disorders, (2) to provide a better understanding of sedatives and analgesic medications which are commonly used in children with developmental disabilities and neurologic disorders on the central nervous system.

To Evaluate the Analgesic Adequacy and Safety of Dexmedetomidine for Intraoperative Sedation and Post-Operative Analgesia in Cerebral Palsy Children Undergoing Lower Limb Surgeries- A Prospective Randomized Single Blinded Case Control Study

“…9 Various analgesics like opioids have been used for sedation and analgesia but it carries side effects like respiratory depression, urinary retention, constipation, sedation, nausea, vomiting, bradycardia and hypotension, purities, chest wall rigidity. 2 Opioids have a direct effect on respiratory centers in the medulla therefore leading to hypoxia and respiratory failure. These side effects are exacerbated in cerebral palsy children.…”

Pathophysiology and Treatment of Severe Traumatic Brain Injuries in Children

“…The classification of medications generally used for sedation is benzodiazepines (e.g., midazolam, lorazepam, diazepam). Benzodiazepines have several advantages for children with severe TBI: sedation, anxiolysis, muscle relaxation, anterograde amnesia, decreased cerebral metabolic rate, and anticonvulsant properties (Kilbaugh et al, 2010). However, clinically important side effects exist that could be detrimental: decreased blood pressure and depressed ventilation (M.…”

Pathophysiology and Treatment of Severe Traumatic Brain Injuries in Children

“…Opioids (e.g., morphine, fentanyl), classified as analgesics agents, can directly affect the respiratory centers in the medulla, leading to a decreased respiratory rate and subsequent increased PaCO 2 (Kilbaugh, Friess, Raghupathi, & Huh, 2010). The increased PaCO 2 can cause vasodilatation of the cerebral vessels and increase ICP and decrease CPP.…”

“…The increased PaCO 2 can cause vasodilatation of the cerebral vessels and increase ICP and decrease CPP. The nurse should monitor for common side effects of opioids: constipation, urinary retention, sedation, nausea, vomiting, respiratory depression, bradycardia, hypotension, and pruritis (Kilbaugh et al, 2010).…”

“…The classification of medications generally used for sedation is benzodiazepines (e.g., midazolam, lorazepam, diazepam). Benzodiazepines have several advantages for children with severe TBI: sedation, anxiolysis, muscle relaxation, anterograde amnesia, decreased cerebral metabolic rate, and anticonvulsant properties (Kilbaugh et al, 2010). However, clinically important side effects exist that could be detrimental: decreased blood pressure and depressed ventilation (M. J.…”