Analgesia, Sedation, Paralytics, Delirium, and Iatrogenic Withdrawal

Valentine, Kevin; Kummick, Janelle

doi:10.1016/j.pcl.2022.01.012

Cited by 2 publications

(4 citation statements)

References 37 publications

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“…Midazolam, a benzodiazepine, is commonly used in conjunction with an opioid in the management of acute and chronic pain to manage agitation (Ng et al., 2017). Midazolam has also been associated with adverse neurological outcomes and concerns have been raised about its safety and efficacy in the neonatal population (Ng et al., 2017; Valentine & Kummick, 2022). Furthermore, midazolam has no analgesic relieving properties and its use may result in over‐sedation and an inability to accurately assess pain (Valentine & Kummick, 2022).…”

Section: Discussionmentioning

confidence: 99%

“…Midazolam has also been associated with adverse neurological outcomes and concerns have been raised about its safety and efficacy in the neonatal population (Ng et al., 2017; Valentine & Kummick, 2022). Furthermore, midazolam has no analgesic relieving properties and its use may result in over‐sedation and an inability to accurately assess pain (Valentine & Kummick, 2022). The addition of dexmedetomidine, a highly selective alpha‐2‐adrenergic receptor agonist with both sedative and analgesic properties (Morton et al., 2021), also resulted in additional feedback.…”

Section: Discussionmentioning

confidence: 99%

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Developing a model of neonatal nurse‐controlled analgesia: A Delphi study

Muirhead,

Kynoch,

Peacock

et al. 2023

Journal of Advanced Nursing

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AimTo develop a nurse‐led model of analgesia to manage post‐operative pain in the surgical neonate.DesignA four‐round e‐Delphi study was conducted from March to December 2022.MethodsAn e‐Delphi method was used seeking a consensus of 70% or greater. Fifty‐one experts were invited to join the panel. Members consisted of multi‐disciplinary healthcare professionals who work in areas associated with neonatal care. In round 1, 49 statements relative to neonatal pain assessment and management were distributed to the panel. Panel members were asked to rate their level of agreeance on a Likert scale from 1 to 5 (1 = strongly disagree to 5 = strongly agree). Ratings equal to or greater than 4 represented agreement, 3 indicated uncertainty and 2 or less disagreement with the proposed statement. An opportunity for free‐text responses after each statement was provided. This iterative process continued for three rounds. In the fourth and final round, the completed model of neonatal nurse‐controlled analgesia was presented along with a further opportunity to provide feedback on the final version.ResultsFour rounds of statements and voting were required to reach consensus on a model of neonatal nurse‐controlled analgesia. The model consists of criteria for use, over‐arching guidelines and three separate pathways based on an individual baby's pain assessment scores, need for pain relieving interventions and time‐lapsed post‐surgical procedure.ConclusionA comprehensive model of neonatal nurse‐controlled analgesia, applicable to the Australasian context, was developed in collaboration with a group of neonatal experts.ImpactThis study provides a multi‐modal family‐integrated model to manage neonatal post‐operative pain. By providing nurses with increased autonomy to assess and manage acute pain, this model has the potential to not only provide a more responsive and individualized approach to alleviate discomfort, but highlights the integral role of parent partnerships in the neonatal intensive care.Reporting MethodThis study was reported in line with the Conducting and REporting of DElphi studies (CREDE) guidance on Delphi studies.Patient or Public ContributionNo patient or public contribution was utilized for this study.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Developing a model of neonatal nurse‐controlled analgesia: A Delphi study

Muirhead,

Kynoch,

Peacock

et al. 2023

Journal of Advanced Nursing

View full text Add to dashboard Cite

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“…The most used pharmacological analgesia in neonates are paracetamol, opioids and local anesthetics [ 44 , 103 ]. The doses and effects of most frequent drugs used in neonates are summarized in Table 5 [ 104 , 105 , 106 , 107 , 108 , 109 , 110 , 111 , 112 ].…”

Section: Treatmentmentioning

confidence: 99%

“…Current guidelines promote a pharmacological therapy administered in a stepwise approach, together with regular assessment of pain and sedation scores [ 53 , 109 , 110 , 111 , 112 ].…”

Section: Treatmentmentioning

confidence: 99%

Evaluation and Treatment of Pain in Fetuses, Neonates and Children

Mencía

Alonso²,

Pallás‐Alonso³

et al. 2022

Children

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The perception of pain is individual and differs between children and adults. The structures required to feel pain are developed at 24 weeks of gestation. However, pain assessment is complicated, especially in neonates, infants and preschool-age children. Clinical scales adapted to age are the most used methods for assessing and monitoring the degree of pain in children. They evaluate several behavioral and/or physiological parameters related to pain. Some monitors detect the physiological changes that occur in association with painful stimuli, but they do not yet have a clear clinical use. Multimodal analgesia is recommended for pain treatment with non-pharmacological and pharmacological interventions. It is necessary to establish pharmacotherapeutic protocols for analgesia adjusted to the acute or chronic, type and intensity of pain, as well as age. The most used analgesics in children are paracetamol, ibuprofen, dipyrone, opioids (morphine and fentanyl) and local anesthetics. Patient-controlled analgesia is an adequate alternative for adolescent and older children in specific situations, such as after surgery. In patients with severe or persistent pain, it is very important to consult with specific pain services.

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Analgesia, Sedation, Paralytics, Delirium, and Iatrogenic Withdrawal

Cited by 2 publications

References 37 publications

Developing a model of neonatal nurse‐controlled analgesia: A Delphi study

Developing a model of neonatal nurse‐controlled analgesia: A Delphi study

Evaluation and Treatment of Pain in Fetuses, Neonates and Children

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