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DOI：10.3310/hta18710.png)
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Abstract
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Background Seriously ill children admitted to paediatric intensive care (PIC) for treatment and supportive therapy require both analgesia and sedation as part of their management to maintain comfort and provide pain relief associated with invasive procedures, mechanical ventilation and the need to lie relatively still. Sedation is also needed to prevent distress from the presence of unfamiliar personnel and from the high level of background noise, which can disturb sleeping patterns.(1) Undersedation and oversedation are both harmful. Inadequate sedation is unacceptable in a vulnerable child: the child may ` fight' the ventilator, leading to ineffective gas exchange, adverse haemodynamic/stress responses, accidental extubation or the loss of invasive access or monitors. In intensive care, agitation and inadequate sedation has been correlated with adverse short- and longer- term outcomes.(2) In contrast, oversedation delays recovery, promotes tolerance to the drugs and leads to distressing symptoms on withdrawal of the drugs: agitation, seizures, hallucinations, psychosis, fever and tachycardia.(3,4) Physician focus in the critically ill child is primarily directed at diagnosis and treatment of the primary disease and often minimal attention is given to the attendant sedation, particularly once the patient has been paralysed with neuromuscular blocking agents. This is reflected in the limited available studies of sedation in the paediatric intensive care unit (PICU), despite common understanding of its problematic nature. This is compounded by the difficulty of undertaking such studies, which require cumbersome observations and recordings of sedation levels, and close observation and manipulation of dose administration to remain within chosen sedation parameters. The limitation of available published data with a large cohort makes the need for a larger-scale trial important but, at the same time, makes planning of such a trial difficult.
Keywords:
ALPHA(2)-ADRENOCEPTOR AGONISTS
RANDOMIZED-TRIALS
ORAL CLONIDINE
RENAL-FUNCTION
SEDATION
ANALGESIA
INFUSION
CARE
CHILDREN
RAT
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