Analgesia and Sedation in the Paediatric Intensive Care Unit: Evidence based or Extrapolation?

In the field of paediatric critical care, there is considerable uncertainty and variation in the area of analgesia and sedation in critically ill children. Consensus guidelines on sedation and analgesia in critically ill children are available since 2006, although clinical practice reveals variations both in pharmacological agents and regimens used. A patient at comfort, free of pain and able to communicate when required, constitutes the current, widely accepted clinical endpoint of analgosedation. Newer agents like remifentanil, which is now widely used in paediatric practice, allowing for the application of newer algorithms of proven efficacy. The introduction of newer analgosedation algorithms definitely presupposes the extended use of pain and comfort assessment, using several, more or less validated tools. The difficulty with children is that with the progress of age and developmental stage, different scales are proposed with varied degrees of difficulty in application. Directing treatment to specific and individualized goals through analgosedation algorithms will assure that the patient's needs are met.