Sedation challenges in the pediatric ICU: is dexmedetomidine the solution?

The pediatric intensive care unit (PICU) poses unique pain and sedation management challenges. Treatment of pain and anxiety in the PICU has historically been accomplished with opioids and benzodiazepines. More recently, drug therapy has been complemented with sedation scales and nonpharmacologic treatment measures, such as parental presence at the bedside and psychologic interventions (i.e. distraction, redirection, etc.), to help create more effective sedation practices and less-threatening PICU environments(1). Even with these measures, critically ill children often need prolonged sedation to facilitate respiratory management, treatment of multi-organ system dysfunction and/or performance of invasive procedures. The consequence is escalating dosages, physiologic tolerance and subsequent development of withdrawal when these agents are discontinued(2). These sedation challenges drive many PICU clinicians to seek alternative pharmacologic agents (even volatile anesthesia) to provide comfort to critically ill children(1).