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Pain, anxiety, fear, distress, and agitation are often experienced by children undergoing medical treatment. Contributory factors may include separation from parents, unfamiliar surroundings, sleep disturbance, and invasive procedures. Children receive analgesia and sedatives to promote comfort, create a safe environment for patient and caregiver, and increase patient tolerance to medical interventions such as intravenous access placement or synchrony with mechanical ventilation. However, using these agents is not without risk. Many of the agents used for analgesia and sedation are considered high alert by the Institute for Safe Medication Practices because of their potential to cause significant patient harm, given their adverse effects and the development of tolerance, dependence, and withdrawal symptoms. Added layers of complexity include the ontogeny of the pediatric patient, ongoing disease processes, and presence of organ failure, which may alter the pharmacokinetics and pharmacodynamics of these medications. Therefore, the pharmacist’s role is vital in forming the best and safest comfort plan and environment for the patient and provider. revIew of MedIcatIons

The primary pillars for safe and effective analgesia and sedation in children are using the lowest effective dose (Table 1-1) with the widest therapeutic index and minimizing adverse effects (Table 1-2). In addition, the pharmacokinetic changes that children undergo across the developmental spectrum must be considered, as must how these will affect each child’s drug exposure.