Use of sedatives and muscle relaxants in newborn babies receiving mechanical ventilation.

In the 1970s sedation or paralysis was rarely considered to be necessary in the ventilatory care of premature infants. We now recognise that infants who 'fight' the ventilator may be at increased risk of a number of important neonatal complications including intracranial haemorrhage and pneumothorax. There is no consensus view on the best way of managing these infants, nor what pharmacological preparations to use in reducing the risks of these complications. When formulating an approach to inhibiting spontaneous respiration in the ventilated neonate there are three important issues to be considered. These are (i) what are the hazards of the infant breathing out of synchrony with the ventilator?, (ii) what are the effects of stress and pain associated with mechanical ventilation?, and (iii) what are the possible adverse effects of drugs used to reduce struggling or stress?