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Post-Operative Sedation and Analgesia

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Pediatric and Congenital Cardiology, Cardiac Surgery and Intensive Care

Abstract

A key aspect of care for the cardiac child in the postoperative period is the provision of appropriate analgesia and sedation, yet relatively little attention has focused on this often-challenging area of care. Appropriate analgesia is important for controlling the stress response to surgery as well as for humanitarian reasons. Analgesic strategies should encompass both the provision of baseline analgesia and the management of breakthrough and procedural pain. Sedation aims to reduce anxiety and distress and facilitates compliance with treatment. There are no ideal analgesic or sedative medications, so the choice of agent represents an inevitable compromise and should be informed by the needs of the specific situation. In the critically ill cardiac child, there is no clear correlation between drug dose and clinical response, so objective assessment of pain and sedation is imperative. The COMFORT scale represents the most suitable clinical assessment tool currently available; there is insufficient evidence as to support the routine use of neurophysiological techniques at present. Tolerance to analgesic and sedative medication and the subsequent appearance of withdrawal symptoms are common, particularly following prolonged or high-dose therapy. Strategies to avoid withdrawal include drug rotation, daily interruption of infusions, and the use of long-acting agents, but no approach appears capable of reliably preventing its occurrence. Future developments include the use of volatile agents such as desflurane and xenon, although there are significant economical and practical limitations to their use.

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Authors and Affiliations

  1. Department of Anesthesia and Pain Medicine, Great Ormond Street Hospital for Children, London, UK

    Ellen Rawlinson & Richard F. Howard

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  1. Ellen Rawlinson
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  2. Richard F. Howard
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Correspondence to Richard F. Howard .

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Editors and Affiliations

  1. Dept. of Pediatric Cardiology, Children's Hospital Colorado, Univ. of Colorado, Denver, Aurora, Colorado, USA

    Eduardo M. Da Cruz

  2. Dept. Pediatric Cardiology, Children's Hospital Colorado, Univ. of Colorado, Denver, Aurora, Colorado, USA

    Dunbar Ivy

  3. Pediatric Cardiac Surgery, Children's Hospital Colorado, Univ. of Colorado, Denver, Aurora, Colorado, USA

    James Jaggers

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Rawlinson, E., Howard, R.F. (2014). Post-Operative Sedation and Analgesia. In: Da Cruz, E., Ivy, D., Jaggers, J. (eds) Pediatric and Congenital Cardiology, Cardiac Surgery and Intensive Care. Springer, London. https://doi.org/10.1007/978-1-4471-4619-3_149

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  • DOI: https://doi.org/10.1007/978-1-4471-4619-3_149

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