Portal de Periódicos da CAPES

SEDATION-ANALGESIA IN THE PEDIATRIC INTENSIVE CARE UNIT

2001; Elsevier BV; Volume: 48; Issue: 3 Linguagem: Inglês

10.1016/s0031-3955(05)70335-7

1557-8240

David M. Polaner,

Cardiac, Anesthesia and Surgical Outcomes

In the pediatric intensive care unit (PICU), many patients are sedated or rendered unconscious for the care of respiratory and multiple organ system dysfunction, for postsurgical management after complex surgeries, or for the performance of invasive procedures. The provision of sedation and analgesia for this care is an integral part of the practice of intensive care medicine. This article addresses the use of sedation and analgesia in the PICU. Although many of the topics discussed have applicability to the general provision of sedation for children, the use of sedative and anesthetic agents for PICU patients is qualitatively different from the use of those same agents in other settings, such as clinics, emergency departments, or radiology suites. It is incumbent on physicians, therefore, to understand and recognize the limits of their experience and expertise in using drugs, no matter how familiar, to produce unconsciousness in an unfamiliar environment or for an unfamiliar procedure. The administration of agents that render a child unconscious and unresponsive to pain is, by definition, the administration of anesthesia, and physicians' ability to provide such care must be within the parameters of their training and credentials. The author believes that intensivists must exercise caution before providing anesthetic care under the rubric of sedation outside of the PICU. It is most prudent not to assume that institutional role without previous consultation with the anesthesia department. By mandate of the Joint Commission for the Accreditation of Healthcare Organizations (JCAHO), the department of anesthesia of a hospital has the responsibility of overseeing and approving the guidelines and protocols used for sedation.* Clinicians also should review the practice guidelines published by the American Society of Anesthesiologists, which are referenced by JCAHO.2 JCAHO has been emphasizing that equal care standards apply throughout a hospital regardless of the location where a procedure takes place or the personnel that perform that procedure.