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Original article
An international survey of management of pain and sedation after paediatric cardiac surgery
  1. Gerdien A Zeilmaker-Roest1,2,
  2. Enno D Wildschut1,
  3. Monique van Dijk1,
  4. Brian J Anderson3,
  5. Cormac Breatnach4,
  6. Ad J J C Bogers2,
  7. Dick Tibboel1
  8. The Paediatric Analgesia after Cardiac Surgery consortium
  1. 1 Intensive Care, Erasmus MC Sophia Children’s Hospital, Rotterdam, The Netherlands
  2. 2 Cardio-Thoracic Surgery, Erasmus MC, Rotterdam, South Holland, The Netherlands
  3. 3 Intensive Care, Starship Children’s Hospital, Auckland, New Zealand
  4. 4 Intensive Care, Our Lady’s Children’s Hospital, Crumlin, Ireland
  1. Correspondence to Drs Gerdien A Zeilmaker-Roest; g.zeilmaker{at}erasmusmc.nl

Abstract

Objective The mainstay of pain treatment after paediatric cardiac surgery is the use of opioids. Current guidelines for its optimal use are based on small, non-randomised clinical trials, and data on the pharmacokinetics (PK) and pharmacodynamics (PD) of opioids are lacking. This study aims at providing an overview of international hospital practices on the treatment of pain and sedation after paediatric cardiac surgery.

Design A multicentre survey study assessed the management of pain and sedation in children aged 0–18 years after cardiac surgery.

Setting Pediatric intensive care units (PICU)of 19 tertiary children’s hospitals worldwide were invited to participate. The focus of the survey was on type and dose of analgesic and sedative drugs and the tools used for their pharmacodynamic assessment.

Results Fifteen hospitals (response rate 79%) filled out the survey. Morphine was the primary analgesic in most hospitals, and its doses for continuous infusion ranged from 10 to 60 mcg kg-1 h-1 in children aged 0–36 months. Benzodiazepines were the first choice for sedation, with midazolam used in all study hospitals. Eight hospitals (53%) reported routine use of sedatives with pain treatment. Overall, type and dosing of analgesic and sedative drugs differed substantially between hospitals. All participating hospitals used validated pain and sedation assessment tools.

Conclusion There was a large variation in the type and dosing of drugs employed in the treatment of pain and sedation after paediatric cardiac surgery. As a consequence, there is a need to rationalise pain and sedation management for this vulnerable patient group.

  • Analgesia
  • Intensive Care
  • Cardiac Surgery
  • Pain
  • Pharmacology

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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