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Pediatric Cardiac Intensive Care Society 2014 Consensus Statement

Pharmacotherapies in Cardiac Critical Care

Sedation, Analgesia and Muscle Relaxant

Lucas, Sarah Scarpace PharmD, BCPS, FCSHP; Nasr, Viviane G. MD; Ng, Angelica J. PharmD, BCPS; Joe, Charlene PharmD; Bond, Meredyth PharmD; DiNardo, James A. MD

Pediatric Critical Care Medicine: March 2016 - Volume 17 - Issue 3_suppl - p S3–S15
doi: 10.1097/PCC.0000000000000619
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Objective: This article reviews pharmacotherapies currently available to manage sedation, analgesia, and neuromuscular blockade for pediatric cardiac critical patients.

Data Sources: The knowledge base of an expert panel of pharmacists, cardiac anesthesiologists, and a cardiac critical care physician involved in the care of pediatric cardiac critical patients was combined with a comprehensive search of the medical literature to generate the data source.

Study Selection: The panel examined all studies relevant to management of sedation, analgesia, and neuromuscular blockade in pediatric cardiac critical patients.

Data Extraction: Each member of the panel was assigned a specific subset of the studies relevant to their particular area of expertise (pharmacokinetics, pharmacodynamics, and clinical care) to review and analyze.

Data Synthesis: The panel members each crafted a comprehensive summary of the literature relevant to their area of expertise. The panel, as a whole, then collaborated to cohesively summarize all the available, relevant literature.

Conclusions: In the cardiac ICU, management of the cardiac patient requires an individualized sedative and analgesic strategy that maintains hemodynamic stability. Multiple pharmacological therapies exist to achieve these goals and should be selected based on the patient’s underlying physiology, hemodynamic vulnerabilities, desired level of sedation and analgesia, and the projected short- or long-term recovery trajectory.

1Department of Clinical Pharmacy, UCSF Medical Center, University of California, San Francisco, San Francisco, CA.

2Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA.

3Department of Clinical Pharmacy, Rady Children’s Hospital, San Diego, CA.

Dr. Lucas disclosed off-label product use. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: James.dinardo@childrens.harvard.edu

©2016The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies