Multiprofessional Critical Care Review: Pediatric 2024 (MCCRCP24ON)-Sedation Analgesia

Sedation Analgesia

Pdf Summary

Dr. Sapna R. Kudchadkar's presentation on "Analgesia, Sedation & Neuromuscular Blockade" covers several critical aspects of pediatric intensive care, especially in the management of sedation and neuromuscular blocking agents (NMBA).<br /><br />Key points include understanding the pros and cons of different drug classes, recognizing conditions like malignant hyperthermia and serotonin syndrome, and acknowledging that benzodiazepines increase the risk of delirium. Sedation is emphasized as a continuum, highlighting the need for tailored approaches in pediatric ICU settings.<br /><br />A clinical case of a 6-year-old boy recovering from acute respiratory distress syndrome illustrates the complexities of weaning from mechanical ventilation and diagnosing muscle weakness, highlighting conditions such as normal cerebrospinal fluid findings and decreased deep tendon reflexes but excluding the association only with aminosteroid NMBA’s.<br /><br />Neuromuscular blocking drugs (NMBAs) are discussed in terms of their uses, mechanisms (depolarizing vs. non-depolarizing), metabolism, and adverse effects. NMBAs are crucial for procedures like tracheal intubation and surgical relaxation but require careful monitoring due to prolonged paralysis and altered sensitivities from factors like electrolyte imbalances or hypothermia.<br /><br />Sedation agents such as benzodiazepines, propofol, etomidate, and ketamine are explored in depth. Benzodiazepine use is decreasing due to associations with delirium, while propofol's rapid effects and risks, including "Propofol Infusion Syndrome," are noted. Ketamine's benefits include maintaining airway reflexes and having bronchodilator properties.<br /><br />Opioids are discussed for their analgesic properties and minimal myocardial depressive effects, though tolerance and dependence can develop. Non-opioid sedatives like dexmedetomidine, phenothiazines, and butyrophenones offer varying benefits and side effects, from maintaining airway reflexes to potential cardiovascular and neuroleptic complications.<br /><br />Lastly, local anesthetics are categorized, their systemic absorption factors, and toxicities management are laid out, emphasizing the importance of the injection site, dose, drug profile, and epinephrine usage.<br /><br />The overarching message of the presentation is to recognize the nuances and adverse effects of each drug, monitor closely, and adjust treatments based on individual patient conditions and responses.

Keywords

Pediatric Intensive Care

Analgesia

Sedation

Neuromuscular Blockade

Benzodiazepines

Malignant Hyperthermia

Serotonin Syndrome

Mechanical Ventilation

Opioids

Local Anesthetics

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