Postoperative sedation and analgesia after pediatric liver transplantation

Transplantation Proceedings
R FumagalliL R Sperti

Abstract

The goal of sedation in the pediatric intensive care unit (PICU) is to produce a calm and comfortable child, free from pain and discomfort. Children receiving liver transplantation need analgesics to control pain from surgical incisions, drains, vascular access, or endotracheal suctioning. Sedatives are used to facilitate the delivery of nursing care, to prevent self-extubation, and to facilitate mechanical ventilation. Optimal sedation produces a state in which the patient is somnolent, responsive to the environment but untroubled by it, and with no excessive movements. A common problem in the PICU is the fluctuation in the delivery of sedatives and analgesics depending on the health care providers and on a breakdown in communication between physicians and nurses to define end points for pharmacological therapy. This variability more often leads to oversedation rather than undersedation. Oversedation delays extubation, promotes ventilator-associated pneumonia, and increases the risk of reintubation. The use of written sedation policies to guide practice at the bedside reduces the length of time for which patients require mechanical ventilation and the length of PICU stay. Protocols for drug administration practices increase pa...Continue Reading

References

May 18, 2000·The New England Journal of Medicine·J P KressJ B Hall
Jun 20, 2001·Pediatric Clinics of North America·D M Polaner
Jul 9, 2003·Critical Care Medicine·S N de WildtJ N van den Anker
May 22, 2004·Paediatric Anaesthesia·Stephen D Playfor, K Venkatesh
Jun 8, 2004·Southern Medical Journal·Joseph D Tobias, John W Berkenbosch
Jun 16, 2004·Intensive Care Medicine·Sara Arenas-LópezIan A Murdoch

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