The Neonatal Pain, Agitation and Sedation Scale reliably detected oversedation but failed to differentiate between other sedation levels

Giordano, Vito; Deindl, Philipp; Kuttner, S; Waldhör, Thomas; Berger, Angelika; Olischar, Monika

doi:10.1111/apa.12770

Cited by 16 publications

(38 citation statements)

References 27 publications

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“…As this is a retrospective study, there are unresolved questions in terms of the optimal fentanyl dose to use, how to avoid possible oversedation and postoperative pain management or prolonged ventilation after treatment. 26 Another limitation of this study is the absence of N-PASS scores for patients under topical and general anaesthesia. These are issues which would need to be addressed by a prospective study.…”

Section: Discussionmentioning

confidence: 97%

Anaesthesia modalities during laser photocoagulation for retinopathy of prematurity: a retrospective, longitudinal study

et al. 2017

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ObjectivesLaser photocoagulation surgery is a routine treatment for threshold retinopathy of prematurity (ROP). However, little is known about which anaesthesia protocols provide efficient pain control while minimising exposure risk to vulnerable infants. In this study, therefore, we assessed the efficacy and tolerability of multiple anaesthesia techniques used on premature infants during laser therapy.Design and main outcome measuresAnaesthesia modalities consisted of topical eye drops anaesthesia, general anaesthesia and intravenous fentanyl sedation with mechanical ventilation. Laser treatment efficacy and detailed operative information were retrospectively and consecutively analysed. Cardiorespiratory stability was assessed and compared. The Neonatal Pain Agitation and Sedation Scale (N-PASS) was used to evaluate tolerability in infants that underwent intravenous fentanyl sedation.Results97 cases of prematurity were included in this study. In 94/97 (96.9%) cases, vascular proliferation regressed. In the topical anaesthesia groups, the ophthalmologist needed 12–16 min more to complete the treatment. During the 3 postoperative days, topical anaesthesia demonstrated the greatest instability; 4/31 (12.90%) infants in this group suffered from life threatening events requiring resuscitation. The only instability observed in general anaesthesia and fentanyl sedation was attributed to difficulty in extubating within 24 hours after surgery. During laser therapy, the N-PASS score increased to 1.8 in the fentanyl sedation group.ConclusionsTopical anaesthesia was associated with more cardiorespiratory instability during ROP laser treatment. While general anaesthesia and fentanyl sedation had similar postoperative cardiorespiratory results, the latter demonstrated acceptable pain stress control. However, the difficulty of weaning off mechanical ventilation in some cases after surgery needs to be addressed in future studies.

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Section: Discussionmentioning

confidence: 97%

Anaesthesia modalities during laser photocoagulation for retinopathy of prematurity: a retrospective, longitudinal study

et al. 2017

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“…However, in some situations during intensive care treatment, in which the use and combination of analgesic and sedative drugs are required, even this way of communication is reduced or completely lost. Since vital signs are also not helpful for the assessment of sedation levels in NICUs patients, other objective methods are needed to manage the patient's sedation as best as possible. To our knowledge, there are no studies investigating the efficacy of different tools to distinguish between different levels of sedation in neonates.…”

Section: Discussionmentioning

confidence: 99%

“…However, clinical scales are not always adequately validated and they carry always a little subjective bias that could influence patient′s assessment. Among a great variety of scales published in the literature, the neonatal pain, agitation and sedation scale (N‐PASS), in particular, has been shown to be an efficient tool, with the ability to differentiate between different sedation levels . Also, neurophysiological methods react to the administration of sedative and analgesic drugs .…”

Section: Introductionmentioning

confidence: 99%

“…Among a great variety of scales published in the literature, the neonatal pain, agitation and sedation scale (N-PASS), in particular, has been shown to be an efficient tool, with the ability to differentiate between different sedation levels. [12][13][14] Also, neurophysiological methods react to the administration of sedative and analgesic drugs. 15 Both amplitude-integrated electroencephalography (aEEG) and Bispectral Index (BIS) are useful tools to monitor the brain activity at the bedside.…”

Section: Introductionmentioning

confidence: 99%

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The power of N‐PASS, aEEG, and BIS in detecting different levels of sedation in neonates: A preliminary study

Giordano

Deindl

Goeral

et al. 2018

Pediatric Anesthesia

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Summary Background Sedatives are essential drugs in every intensive care unit in order to ensure the patient's optimal level of comfort. Avoiding conditions of over‐ and under‐sedation is a challenge in a neonatal intensive care setting. Drug administration could be optimized by the concomitant use of objective methods to assess the level of sedation. Aims We aimed to look at the ability of different methods (Neonatal Pain, Agitation and Sedation Scale, amplitude‐integrated Electroencephalogram, and Bispectral Index), and their combination, in detecting different level of sedation. Methods Twenty‐seven neonates among whom 17 were receiving sedatives with or without opiate analgesics were monitored using the Neonatal Pain, Agitation and Sedation Scale, the amplitude‐integrated Electroencephalogram, and the Bispectral Index. According to the expert opinion of two trained neonatologists, patients were categorized into three groups: no, light, and deep sedation. Four hours of simultaneous assessment of the Neonatal Pain, Agitation and Sedation Scale scores, Burdjalov scores (to summarize the amplitude‐integrated Electroencephalogram trace), and Bispectral Index values were considered for the comparative analysis across these groups. Results All three methods could differentiate patients who were not sedated from those who were deeply sedated: median score 12 and 9, respectively, (95% CI of difference = 1.99‐5.99, P = 0.001) for the amplitude‐integrated Electroencephalogram Burdjalov score; median 1 and −5, respectively, (95% CI of difference = 2.99‐8.00, P = 0.001) for the Neonatal Pain, Agitation and Sedation Scale; and median 48 and 37, respectively, (CI of difference = 1.77‐22.00, P = 0.043) for the Bispectral Index. However none of them, used alone, was able to differentiate light and deep sedation: median score 10 and 9, respectively, for the amplitude‐integrated Electroencephalogram Burdjalov score; median −2 and −5, respectively, for the Neonatal Pain, Agitation and Sedation Scale; and median 48 and 37, respectively, for the Bispectral Index. Only the amplitude‐integrated Electroencephalogram and the Neonatal Pain, Agitation and Sedation Scale were able to differentiate between the conditions of no sedation and light sedation. Also, according to the area under the curves values, the combination of the Neonatal Pain, Agitation and Sedation Scale with the Burdjalov score derived from the amplitude‐integrated Electroencephalogram showed the best accuracy in differentiating light and deep sedation. Conclusion While none of the three methods alone was able to precisely differentiate between different levels of sedation, we suggest that using a combination of amplitude‐integrated Electroencephalogram and Neonatal Pain, Agitation and Sedation Scale can be useful to distinguish between light and deep sedation in neonatal patients.

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“…Beurteilung von Sedierungstiefe und Schmerzen bei längerzeitig beatmeten und postoperativen Früh-und Reifgeborenen 620,626 620,626,649,[656][657][658][659] .…”

Section: Neonatal Pain Agitation and Sedation Scale (N-pass)unclassified

Das Delir — Verwirrung mit schweren Komplikationen

Köbke¹

2018

Pflegez

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The Neonatal Pain, Agitation and Sedation Scale reliably detected oversedation but failed to differentiate between other sedation levels

Abstract: The N-PASS sedation subscale reliably detected oversedation, but failed to differentiate between adequate and undersedation. We therefore recommend using additional methods to ensure adequate assessment of sedation in neonates.

Cited by 16 publications

References 27 publications

Anaesthesia modalities during laser photocoagulation for retinopathy of prematurity: a retrospective, longitudinal study

Anaesthesia modalities during laser photocoagulation for retinopathy of prematurity: a retrospective, longitudinal study

The power of N‐PASS, aEEG, and BIS in detecting different levels of sedation in neonates: A preliminary study

Das Delir — Verwirrung mit schweren Komplikationen

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