SEDATION AND ANALGESIA IN PEDIATRIC-PATIE NTS

Pediatric patients in intensive care units experience pain and stress as a result of care procedures, invasive investigations, insertion of vascular lines, and environmental noise. It has been established that pain is felt in the neonatal period and induces significant metabolic and physiological alterations. Benzodiazepines, muscle relaxants, mino r analgesics and opiates appropriately combined by practioners familia r with their mode of action provide sedation and analgesia adapted to each invasive procedure or disease. Benzodiazepines are nonanalgesic s edatives that reduce recall of the painful event; they should always b e given concomitantly with an analgesic. Opiates are the most potent a nalgesics but are also respiratory depressants with highly variable ph armacokinetic characteristics in the neonatal period, requiring concom itant assisted ventilation. Muscle relaxants paralyze striated muscles but have no analgesic effects and can be used only concomitantly with major sedatives or analgesics in patients receiving ventilatory assis tance. Nonpharmacological treatments play a key role. Published data s upporting the use of these various tools are presented, and modes of a ctions, modalities of use and indications are discussed.