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Analgesia and Sedation for Painful Interventions in Children and Adolescents ()
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Propofol: a review of its role in pediatric anesthesia and sedation. CNS Drugs. Mechanisms whereby propofol mediates peripheral vasodilation in humans. Sympathoinhibition or direct vascular relaxation?. A presedation fluid bolus does not decrease the incidence of propofol-induced hypotension in pediatric patients. There is a need for further research regarding sedation and analgesia practices in India. The ASA guidelines recommended that only personnel with training in the delivery of general anesthesia should administer sedation as it is likely that children may pass into a deeper level of sedation than originally intended.
Though professional skill and knowledge remain the determining factors, the goal should be to practice and promote safe sedation and analgesia.
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The introduction of newer pharmacologic agents and better monitoring devices helped us to achieve this. With an ever increasing load of out of operating room procedures, non-anesthesiologists should be formally trained to deliver PSA and manage complications should they occur. Source of Support: Nil. Conflict of Interest: None declared. National Center for Biotechnology Information , U. Journal List J Pediatr Neurosci v. J Pediatr Neurosci. Charu Mahajan and Hari Hara Dash 1.
Author information Copyright and License information Disclaimer. Address for correspondence: Dr. E-mail: moc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3. This article has been cited by other articles in PMC.
Abstract A spectrum of conditions requires sedation and analgesia in pediatric population. Keywords: Analgesia, children, procedural sedation. Introduction With the better understanding of the developmental neurobiology, it is now a well recognized fact that nervous system is sufficiently sensitive to nociception even before birth, and thus, children should not be undertreated for pain. Open in a separate window. Table 2 Pain scales.
Pre-sedation assessment for procedure Children undergoing sedation should be evaluated beforehand according to the preoperative assessment guidelines of the American Society of Anesthesiologists ASA. Equipment and emergency drugs It is necessary to have appropriate equipment, monitoring, and reliable back up help before instituting sedation for a procedure in a child.
Monitoring Standard non-invasive monitoring should be used in all patients, which includes ECG, BP, pulse oximetry, respiratory rate, and capnography. Special considerations for infants and children Most analgesics including opioids and local anesthetics are conjugated in the liver. Pharmacology of the drugs The guiding principle for analgesic administration is the step ladder approach to pain. Opioids With the advent of short-acting opioids, morphine is no longer preferred for short procedures.
Barbiturates Pentobarbital produces a deep sleep with minimal movement and is popular for use during radiological non-invasive procedures. Chloral hydrate Chloral hydrate is a pure sedative-hypnotic drug without analgesic properties, once widely used during non-painful diagnostic procedures. Propofol The emergency department, gastroenterology, and critical care literature showed that propofol can be given to children in these settings with good efficacy, apparent safety, and rapid recovery. Etomidate Etomidate has a rapid onset of action, a short duration agent with a relatively mild adverse effect profile.
Dexmedetomidine Dexmedetomidine is a highly selective alpha-2 adrenoreceptor agonist with sedative, anxiolytic, and mild analgesic properties with no depressant effect on respiratory drive. Table 3 Ideal agent for procedural sedation and analgesia. Table 4 Comparative properties of different drugs.
Indian scenario In Indian context, use of agents like remifentanil, dexmedetomidine, and etomidate is restricted due to their non-availability or limited supply. Conclusion Though professional skill and knowledge remain the determining factors, the goal should be to practice and promote safe sedation and analgesia.
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