Sedation and Analgesia
Management of sedation and analgesia in the pediatric patient after cardiac surgery and cardiopulmonary bypass is of particular importance in the setting of decreased cardiac function and increased metabolic oxygen demands secondary to inflammatory responses. Important considerations include the relief of pain and anxiety, attenuation of the stress response, and maintaining mechanical ventilation synchrony. Opioid and benzodiazepine medications have historically been the mainstay sedative and analgesic agents in the intensive care unit, and they do indeed still have an important role. Still, other agents, such as dexmedetomidine, ketamine, propofol, and neuromuscular blockers, will help to provide a more balanced and tailored sedative and analgesic plan in order to maintain a level of non-agitation and hemodynamic stability in a wide variety of pediatric patients with specific needs. Additionally, many pediatric patients with congenital cardiac disease will require extracorporeal membrane oxygenation, which presents many pharmacokinetic implications that will significantly alter the pharmacodynamic effects of some of these drugs. Thus, the understanding of these alterations and the ability to adapt the patient’s sedative and analgesic plan to account for them is a necessity.
