Pain, fentanyl consumption, and delirium in adolescents after scoliosis surgery: dexmedetomidine vs midazolam

Aydoğan, Mustafa Said; Korkmaz, Medet; Özgül, Ülkü; Erdoğan, Mehmet Ali; Yücel, Aytaç; Karaman, Abdurrahman; Toğal, Türkan; Durmuş, Mahmut; Çolak, Cemil

doi:10.1111/pan.12128

Cited by 57 publications

(40 citation statements)

References 25 publications

(31 reference statements)

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“…Although benzodiazepines provide the benefits of amnesia, anxiolysis, and sedation, one major disadvantage is the increased risk of delirium with prolonged administration. (4, 5, 12, 33) Adult guidelines for long-term sedation recommend lorazepam, based on high-grade evidence that lorazepam infusions require fewer dosage adjustments, require less time to achieve adequate sedation, and provide more predictability for awakening times and time to extubation compared to midazolam. (14, 34, 35) Midazolam pharmacokinetics and pharmacodynamics have been shown to change with age, leading to significant inter-individual variability.…”

Section: Discussionmentioning

confidence: 99%

“…(2, 3) In addition, benzodiazepines are a strong independent risk factor for the development of delirium. (4, 5) ICU delirium increases morbidity and mortality in critically ill adults, and emerging evidence suggests that delirium may be clinically relevant in critically ill children. (6–9) Normal sleep-wake homeostasis has a critical role in immunity and thermoregulation, as well as prevention of delirium and the development of a catabolic state, which may influence the rate of recovery from critical illness.…”

Section: Introductionmentioning

confidence: 99%

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Sedation, Sleep Promotion, and Delirium Screening Practices in the Care of Mechanically Ventilated Children

Kudchadkar

Yaster

Punjabi

2014

Critical Care Medicine

189

183

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Objective To examine pediatric intensivist sedation management, sleep promotion, and delirium screening practices for intubated and mechanically ventilated children. Design An international, online survey of questions regarding sedative and analgesic medication choices and availability, sedation protocols, sleep optimization, and delirium recognition and treatment. Setting Member societies of the World Federation of Pediatric Intensive and Critical Care Societies were asked to send the survey to their mailing lists; responses were collected from July 2012 to January 2013. Interventions Survey Measurements and Main Results The survey was completed by 341 respondents, the majority of whom were from North America (70%). Twenty-seven percent of respondents reported having written sedation protocols. Most respondents worked in pediatric intensive care units (PICUs) with sedation scoring systems (70%), although only 42% of those with access to scoring systems reported routine daily use for goal-directed sedation management. The State Behavioral Scale was the most commonly used scoring system in North America (22%), with the COMFORT score more prevalent in all other countries (39%). The most commonly used sedation regimen for intubated children was a combination of opioid and benzodiazepine (72%). Most intensivists chose fentanyl as their first-line opioid (66%) and midazolam as their first-line benzodiazepine (86%), and prefer to administer these medications as continuous infusions. Propofol and dexmedetomidine were the most commonly restricted medications in PICUs internationally. Use of earplugs, eye masks, noise reduction, and lighting optimization for sleep promotion was uncommon. Delirium screening was not practiced in 71% of respondent’s PICUs, and only 2% reported routine screening at least twice a day. Conclusions The results highlight the heterogeneity in sedation practices among intensivists who care for critically ill children, as well as a paucity of sleep promotion and delirium screening in PICUs worldwide.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Sedation, Sleep Promotion, and Delirium Screening Practices in the Care of Mechanically Ventilated Children

Kudchadkar

Yaster

Punjabi

2014

Critical Care Medicine

189

183

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“…Enthusiasm for these agents is driven by the absence of clinically significant respiratory depression (49, 50), which is an advantage in the spontaneously breathing patient or when extubation is planned (51). Moreover, they do not show neurotoxicity in animals (52), have opioid and benzodiazepine sparing properties (53, 54), and may decrease the incidence of withdrawal and delirium (55). A RCT comparing continuous intravenous clonidine and midazolam in 129 ventilated children (30 days to 15 years) showed a similar sedative effect (56).…”

Section: Commonly Used Agentsmentioning

confidence: 99%

Sedation in Critically Ill Children with Respiratory Failure

Vet¹,

Kleiber²,

Ista³

et al. 2016

Front. Pediatr.

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This article discusses the rationale of sedation in respiratory failure, sedation goals, how to assess the need for sedation as well as effectiveness of interventions in critically ill children, with validated observational sedation scales. The drugs and non-pharmacological approaches used for optimal sedation in ventilated children are reviewed, and specifically the rationale for drug selection, including short- and long-term efficacy and safety aspects of the selected drugs. The specific pharmacokinetic and pharmacodynamic aspects of sedative drugs in the critically ill child and consequences for dosing are presented. Furthermore, we discuss different sedation strategies and their adverse events, such as iatrogenic withdrawal syndrome and delirium. These principles can guide clinicians in the choice of sedative drugs in pediatric respiratory failure.

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“…In particular, benzodiazepines are a risk factor for delirium, particularly with prolonged administration. [23][24][25][26] These drugs should be titrated or discontinued when no longer necessary for treatment. 7 Guidelines for the management of delirium in adult ICU patients recommend continuous intravenous infusions of dexmedetomidine rather than benzodiazepine for sedation, and this strategy may also be appropriate for PICU patients.…”

Section: Advantages and Disadvantagesmentioning

confidence: 99%

“…• Room in a quieter part of the pediatric intensive care unit, away from unit traffic and activity for child with hyperactive or mixed delirium 2,17 • Room near more active area of the unit, with ageappropriate interactions with surroundings, for child with hypoactive delirium 2,17 Decorate room with familiar pictures of home, family, friends, and favorite pets 7,24,25 Have on hand favorite toys, blankets, music, and personal items 11,17,23,28 Use physical restraints as a last resort; their use may increase agitation and create additional problems, such as loss of mobility and prolonged confusion 20,23,[28][29][30] Children who need glasses or hearing aids should wear them when possible…”

Section: Promotion Of Sleepmentioning

confidence: 99%

Delirium in Children: Identification, Prevention, and Management

Bettencourt

Mullen

2017

Critical Care Nurse

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Delirium in children is an often underrecognized but serious complication of hospitalization. Delirium in this age group has been described as behaviors such as refractory agitation and restlessness, visual or auditory hallucinations, children being "not themselves," and a lethargic state. Often, children with delirium are at risk for harming themselves by dislodging tubes, falling, or refusing care. Pediatric nurses must recognize and intervene to prevent and treat delirium in hospitalized children because the delirium may be an indicator of worsening clinical status and is associated with high mortality and morbidity in children of all ages and with posttraumatic stress disorder. Pediatric nurses are uniquely positioned to design care interventions to both reduce risk for delirium and treat active delirium. Many treatment recommendations are nonpharmacological and are part of excellent nursing care. (Critical Care Nurse. 2017; 37[3]:e9-e18)

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Pain, fentanyl consumption, and delirium in adolescents after scoliosis surgery: dexmedetomidine vs midazolam

Abstract: Dexmedetomidine was associated with the decreased postoperative fentanyl consumption, NVAS scores, and a decreased incidence of delirium. These findings may be beneficial for managing sedation protocols in adolescents who have undergone scoliosis surgery.

Cited by 57 publications

References 25 publications

Sedation, Sleep Promotion, and Delirium Screening Practices in the Care of Mechanically Ventilated Children

Sedation, Sleep Promotion, and Delirium Screening Practices in the Care of Mechanically Ventilated Children

Sedation in Critically Ill Children with Respiratory Failure

Delirium in Children: Identification, Prevention, and Management

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