Sedation and analgesia using opioids and benzodiazepines is frequently required in
critically ill children to minimize pain and anxiety. In some patients, difficult
sedation occurs when tolerance or unacceptable side effects limit the efficacy of
conventional analgo-sedative treatment. We describe seven patients (age range 1 to
17 yr) where difficult sedation was successfully managed with enteral levomepromazine
(LMZ). LMZ is a neuroleptic antipsychotic agent that exhibits potent analgo-sedative
properties without respiratory depression, through non-opioid and non-benzodiazepine
pathways. We describe its use in our pediatric intensive care unit to control agitation
in patients with known behavioral disorders who frequently pose a significant sedation
challenge. We also illustrate its successful use in cases of withdrawal syndrome and
delirium, and discuss the association of fever and its distinction from neuroleptic
malignant syndrome in two patients. LMZ should be considered as a useful sedative
in critically ill children where difficult sedation occurs and conventional agents
are exhausted.
Keywords
Methotrimeprazine - antipsychotic agents - deep sedation - psychomotor agitation -
pediatric intensive care units - neuroleptic malignant syndrome - substance withdrawal
syndrome - delirium
