• Paediatric sedation
• ITU
• Considerable variation
• Commonly midazolam and morphine in the uk
• Analgesic agents used
• Simple analgesics
• Regional anaesthesia
• Opioids
• Morphine
• 10-60μcg/kg/hr
• Fentanyl
• 4-10μcg/kg/hr
• Remifentanil
• Sedatives used
• Benzodiazepines
• Midazolam
• 2-10μcg/kg/hr
• Clonidine
• 0.1-2μcg/kg/hr
• Enteral sedatives
• Chloral hydrate
• Promethazine
• Assessment of pain
• Behavioural observation in children under 3
• Facial
• Physiological
• Motor responses
• 3-8
• Self reporting techniques
• >8
• VRS
• VAS
• Measuring sedation
• COMFORT scale
• Measures MAP, HR, muscle tone, facial tension, alertness, respiratory behaviour, calmness/agitation an physical movement
• Neurophysiological monitors
• BIS
• Doesn't correlate very well with COMFORT
• Practical difficulties
• Recommendations for sedation in critically ill children
• Children have a right to pain relief
• Correction of environmental factors should be addressed
• Normal sleep should be encouraged
• Pain should be assessed by a regular & appropriate method
• Therapeutic plan should be established for each patient
• Continuous infusion of morphine or fentanyl for severe pain
• NSAIDs and paracetamol as adjuncts where possible
• Local and regional considered
• Asess sedation using COMFORT or validated score
• Desired level of sedation regularly assessed
• Midazolam and clonidine are both appropriate
• Early use of enteral sedation should be considered
• Withdrawl syndrome should be considered after 7 days of therapy
• CEACCP
  Link:ceaccp.oxfordjournals.org/content/8/3/90.full.pdf?sid=c0725058-6829-41ab-b704-0957fe916928