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Analgesic Use in the Pediatric Intensive Care Unit

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Sedation and Analgesia for the Pediatric Intensivist

Abstract

Critically ill children frequently experience pain either as a consequence of their primary reason for pediatric intensive care unit (PICU) admission, required diagnostic and therapeutic procedures, or even routine care. Administering sedative and analgesic infusions to blunt awareness is no longer a standard of care and may contribute to the development of tolerance and withdrawal, delirium, and post-intensive care syndrome among other agent-related unique adverse effects. Multimodal analgesia incorporating non-opioid analgesics is an important strategy in critically ill children. Ontogeny of pediatric pharmacodynamics requires age-specific consideration regarding drug selection and dosing. Acetaminophen and nonsteroidal anti-inflammatory drug (NSAID) co-administration provides effective management of mild to moderate pain with addition of opioids if escalation is needed to manage moderate to severe pain. If opioids are ineffective and dose escalation is limited by side effects, adjunctive medications, including ketamine, dexmedetomidine, or gabapentin, may optimize pain management. While critically ill children are closely monitored, certain higher-risk populations, such as those with obstructive sleep apnea (OSA), obesity, and cardiopulmonary disease, are at potentially higher risk for opioid-related adverse effects and should be monitored accordingly.

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Authors and Affiliations

  1. Case Western Reserve University, Cleveland, OH, USA

    Anne Stormorken

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  1. Anne Stormorken
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Correspondence to Anne Stormorken .

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Editors and Affiliations

  1. Associate Professor of Pediatrics, Emory University School of Medicine, Department of Pediatrics, Division of Pediatric Critical Care Medicine, Children’s Healthcare of Atlanta at Egleston, Atlanta, GA, USA

    Pradip P. Kamat

  2. Professor of Pediatrics/Pediatric Critical Care, University of Louisville, “Just For Kids” Critical Care Center, Norton Children’s Hospital, Louisville, KY, USA

    John W. Berkenbosch

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Stormorken, A. (2021). Analgesic Use in the Pediatric Intensive Care Unit. In: Kamat, P.P., Berkenbosch, J.W. (eds) Sedation and Analgesia for the Pediatric Intensivist. Springer, Cham. https://doi.org/10.1007/978-3-030-52555-2_3

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  • DOI: https://doi.org/10.1007/978-3-030-52555-2_3

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  • Online ISBN: 978-3-030-52555-2

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