Sedation & Analgesia - pain and sedation in PICU

MAPS = Multidisciplinary Assessment of Pain Scale (https://onlinelibrary.wiley.com/doi/10.1111/j.1460-9592.2007.02325.x#t1)

SBS = State Behaviour Scale (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1626525/table/T3/)

Ensure adequate analgesia THEN deal with sedation.

ALWAYS bolus drugs if analgesia and/or sedation is inadequate.

Assess MAPS and SBS every 4 hours and after any change in medication.

Diagnosing the cause of pain is important and will guide treatment, e.g:

1. Remove painful tubes / lines

2. Treatment of GI spasm

3. Drainage of tense ascites etc

Transdermal clonidine can be used in stable patients. Transdermal patches come in:

1. 100mcg/day (TTS1)

2. 200mcg/day (TTS2)

3. 300mcg/day (TTS3)
   and are applied weekly. The maximum dose is around 15mcg/kg/day.

Patients who are cardiovascularly unstable may be very sensitive to analgesics and sedatives. If giving boluses you need to monitor the patient closely, give the dose slowly, and you may need to decrease the dose.

Patients can become very resistant to sedatives/analgesics over time and may require very high doses to achieve satisfactory sedation and analgesia. These patients are at high risk of withdrawal if these drugs are suddenly ceased.