Pain Management and Conscious Sedation for the Pediatric Patient

Pain management in children was previously ignored primarily because of myths and misconceptions about childhood pain. Undertreatment of pain was once a common and accepted practice. However, in recent years, with increased knowledge and understanding coupled with improved pain assessment tools, health care providers are more conscious about providing adequate and safe analgesia to children. Because of the differences in patient response to various pharmacological agents, it is important to understand the pharmacokinetic and pharmacodynamic differences of the various agents. Choices of pain management should be individualized, and adjustments should be made based on the patient's clinical condition. Conscious sedation before diagnostic and therapeutic procedures should be approached with caution. Deaths and complications related to conscious sedation therapy have prompted the development of guidelines for safer and more effective pharmacological interventions. The recently published guidelines include recommendations for skilled personnel, continuous monitoring, appropriate use of drugs, and ability to manage unforeseen complications. Selection of the most appropriate sedatives should take into consideration the type of procedure, the patient's clinical condition, and the desired level and duration of consciousness. Similar to pain management, individualization is crucial. This article will discuss the principles of pain management and conscious sedation in children. Facts and scientific findings will be presented to discredit the myths and misconceptions often associated with pediatric pain. Various pain assessment tools will be summarized. The newly published sedation guidelines set forth by the American Academy of Pediatrics Committee on Drugs will be briefly discussed. Furthermore, commonly used agents will be reviewed. Copyright © 1996 by W.B. Saunders Company