P44 Alfentanil for analgesia and sedation in children’s critical care

Introduction Safe and effective sedation analgesia in children’s critical care is a complex area of medicines use. Analgesia are needed to treat any pain during stay, also facilitate the delivery invasive interventions such as mechanical ventilation intravenous access devices. Strong opioids group often used achieve good relief. In adult care, alfentanyl has become opioid choice it reduces length stay. 1 2 This could be attributed pharmacokinetic profile alfentanyl. Alfentanyl does not distribute widely into body tissue like fentanyl, dependent on kidney function removed from morphine or oxycodone. 3 Most units UK use either fentanyl. 4 The aim this case report describe alfentanil patient assess outcome. Situation was 2-month-old (weight = 2.6kg) who had truncus arteriosus repair at nine weeks age. initial postoperative course complicated by high pulmonary pressures heart failure that required further operation. Following cardiovascular instability four days extracorporeal membrane oxygenation (ECMO) support. clinical team felt adequate essential keeping patient’s blood pressure under control, avoid exacerbating may have another period ECMO Sedation already been titrated using fentanyl infusion 7 microgram/kg/hour, clonidine microgram/kg/hour chloral hydrate rectal 200 mg/kg/day divided doses. Midazolam after cardiac surgery unit due concerns about side effects. Unfortunately, enteral feeds so given via route. reduced urine output creatinine trend showed an acute injury. oxygen saturations dropped when they became agitated routine cares procedures. As deemed working stopped started 30 microgram/kg/hour. dose quickly escalated maximum recommended 120 little improvement seen, ultimately ketamine which proved effective. Eventually, feeding established, addition promethazine helped converted morphine. Lesson Learned there benefit substituting for prolonged hospital admission. If demonstrate benefits seen then should studied early period. There many unanswered questions care. These include whether more than others, how escalate difficult manage patients, cycling sedative agents. References Richards-Belle A, Canter R, Power G, et al . National survey point prevalence study practice Critical Care 2016; 20 :355. Manley N, Fitzpatrick Long T, Jones P. A cost analysis + propofol vs midazolam critically ill patients. PharmacoEconomics 1997; 12 :247–255. Piramal Ltd. Rapifen – Summary Product Characteristics. [Internet]. Surrey, UK; Electronic Medicines Compendium. [updated 5th November 2021]. Available from: https://www.medicines.org.uk/emc/product/9776/smpc [Accessed 17th June 2022] Jenkins I, Playfor S, Bevan C, Davies Wolf A. Current United Kingdom pediatric intensive Paediatric Anaesthesia 2007; 17 :675–683.