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Intermittent Versus Continuous and Intermittent Medications for Pain and Sedation After Pediatric Cardiothoracic Surgery; A Randomized Controlled Trial.

Intermittent Versus Continuous and Intermittent Medications for Pain and Sedation After Pediatric Cardiothoracic Surgery; A Randomized Controlled Trial.
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Penk JS, Lefaiver CA, Brady CM, Steffensen CM, Wittmayer K,


Penk JS, Lefaiver CA, Brady CM, Steffensen CM, Wittmayer K, (click to view)

Penk JS, Lefaiver CA, Brady CM, Steffensen CM, Wittmayer K,

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Critical care medicine 2017 10 12() doi 10.1097/CCM.0000000000002771
Abstract
OBJECTIVES
Compare continuous infusions of morphine and midazolam in addition to intermittent doses with an intermittent only strategy for pain and sedation after pediatric cardiac surgery.

DESIGN
Randomized controlled trial.

SETTING
Advocate Children’s Hospital, Oak Lawn, IL.

PATIENTS
Sixty patients 3 months to 4 years old with early extubation after pediatric cardiac surgery.

INTERVENTIONS
Patients received a continuous infusion of morphine and midazolam or placebo for 24 hours. Both groups received intermittent morphine and midazolam doses as needed.

MEASUREMENTS AND MAIN RESULTS
Gender, age, bypass time, and surgical complexity were not different between groups. Scheduled ketorolac and acetaminophen were used in both groups and were not associated with adverse events. The mean, median, and maximum Faces, Legs, Activity, Cry, And Consolability score were not different between groups. There was no significant difference in number of intermittent doses received between groups. The total morphine dose was higher in the continuous/intermittent group (0.90 vs 0.23 mg/kg; p < 0.01). The total midazolam dose was also higher in the continuous/intermittent group (0.90 vs 0.18 mg/kg; p < 0.01). The hospital length of stay was longer in the continuous/intermittent group (8.4 vs 4.9 d; p = 0.04). CONCLUSIONS
Pain was not better controlled with the addition of continuous infusions of morphine and midazolam when compared with intermittent dosing only. Use of continuous infusions resulted in a significantly higher total dosage of these medications and a longer length of stay.

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