Abstract
Endotracheally intubated (El) patients usually require some combination of sedative (morphine = M, Valium = V) and paralyzing (Pavulon = P) medications to minimize anxiety, discomfort, and the risks of self-extubation, tracheal injury, and pulmonary barotrauma. We reviewed a database of all admissions to a Pediatric ICU to find patients who were EI for >=7 full days (excluding days of intubation and extubation). We excluded cases where MVP administration would be influenced by neurological (encephalopathy, seizures, muscle weakness, mental retardation), cardiovascular (shock), or painful diagnoses (malignancy, trauma, burns, surgical incisions).
Thirty-one cases were selected, and the daily sum of MVP dosages was calculated for each case for each of the 7 study days. This was valid since the starting dose (0.1 mg/kg) and interval (q2h PRN) were the same for each drug. We sought to confirm our clinical impression that the patients aged 6m-2y required more MVP than younger or older patients by using the Mann-Whitney U-test for non-parametric comparisons.
Thus, it appears that because of either behavioral or pharmacologic idiosyncrasy, patients aged 6m-2y often require double the dosage of MVP usual for younger or older patients.
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Mickell, J., Pedigo, S. MORPHINE, VALIUM, AND PAVULON REQUIREMENT VERSUS AGE IN ENDOTRACHEAL INTUBATED CHILDREN. Pediatr Res 21 (Suppl 4), 204 (1987). https://doi.org/10.1203/00006450-198704010-00229
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DOI: https://doi.org/10.1203/00006450-198704010-00229