Chapter 12
SEDATION AND ANALGESIA
Jill Zalieckas, MD
Christopher Weldon, MD, PhD.^
(^) I. Introduction
The alleviation of pain and anxiety is an important component of caring
for the critically ill infant and child. Children in the intensive care unit require
sedation and analgesia as adjuncts to procedures, facilitate mechanical
ventilation, and assist with post-operative management and care. The goals of
sedation are to ensure the patient’s safety, minimize physical discomfort and
pain, control anxiety, minimize psychological trauma, and control behavior and
movement [1]. Adequate sedation and analgesia also have benefits of reducing
the stress response and catabolism associated with surgery [2]. The approach
to sedation and analgesia management has implications for a child’s overall
hospital course in the intensive care unit. Specifically, ventilator days, ICU
length of stay, risk of nosocomial infections, unplanned extubation, and risk of
withdrawal are all morbidities that are increased with prolonged or ineffective
sedation regimens [3,4]. The following chapter outlines the impact of sedation
regimens on morbidity in neonatal and pediatric ICUs and highlights the various
pharmacologic agents commonly used for sedation and analgesia in the
intensive care unit.
II. Impact of Sedation in the ICU
There are 4 levels of sedation as defined by the American Academy of
Pediatrics. Minimal sedation (anxiolysis) is a drug-induced state whereby
patients are sedate but able to respond normally to verbal commands. There is
no significant change in cardiovascular or respiratory function. Moderate