There are two main areas where sedation is required—during procedures and whilst receiving paediatric intensive care.
There are many sedative agents available. All sedative agents decrease conscious level and, thereby, can have significant toxicity. The choice of sedative agent depends upon local experience and how quickly and for how long sedation is needed. If a child is likely to be difficult to sedate, then consider whether a short-acting general anaesthetic, administered by a paediatric anaesthetist, is safer and kinder to the child.
The purpose of sedation in the paediatric intensive care unit (PICU) is to help the child not the health professional. IV midazolam is the drug of choice on admission. Subsequently, once NG feeds are tolerated, chloral hydrate and promethazine have been shown to be more effective than midazolam. Propofol is contraindicated for use in the PICU, with the exception for procedures, in view of the risk of a fatal ADR.