B. Barbiturates [2,13]^
Barbiturates globally depress the central nervous system. They do not
have anxiolytic or analgesic properties.
- Phenobarbital
Clinical indications: anticonvulsant. Routine use for sedation
discouraged
Clinical effects: Hyperalgesic effects – may increase
requirement for analgesia. Rapid tolerance.
Advantages: increased bilirubin metabolism, mild
cardiovascular and respiratory depression
Dosing: Loading dose: 5-20mg/kg. Maintenance dose:
2.5mg/kg q12 hours PO or IV for sedation
Onset & elimination: very slow onset. Prolonged elimination
half life in infants (5-6 days)
Precautions: May increase risk of intraventricular hemorrhage
in premature neonates - Pentobarbital
Clinical indications: Adjunct for sedation of intubated child
when tolerance to benzodiazepines and opioids has occurred
Dosing: Intermittent doses: 0.5 - 2 mg/kg q4 hours