1128: Paralysis As An Adjunct To Sedation And Analgesia On The First Post-operative Day After Pediatric Abdominal Organ Transplantation

Very high doses of narcotics and benzodiazepines are often needed for sedation and analgesia after extensive abdominal surgery in children, with the potential for excessive sedation, prolonged ventilation and withdrawal. We hypothesized that neuromuscular blockade used as an adjunct to sedation and analgesia during the first postoperative day would decrease need for treating withdrawal without increasing ventilator days and PICU length of stay (LOS). Starting in July 2011, we gave a weakening dose of atracurium during the first 24 hours after surgery in addition to usual fentanyl, benzodiazepines, morphine and dexmedetomidine to pediatric single or multiple abdominal organ transplant recipients (Group P, n=12). Cumulative narcotic doses given during the first 48 hrs and need for methadone-lorazepam on transfer out of the PICU were compared with a non-paralyzed cohort (Group NP, n=12) from the previous year. Patients with early surgical complications were excluded from analysis. There were no differences in demographics including age, diagnosis and type of transplant. For Group P vs. Group NP, median fentanyl used (µg/Kg/day) was 46.0 (29.7-69.7) vs 24.6 (24.1-29.6) (P= 0.036, Mann-Whitney). Methadone-lorazepam treatment on transfer out of the PICU was less common in Group P (P= 0.046, Fisher’s exact test) with no increase in ventilator days or PICU-LOS as compared to Group NP. We conclude that the use of brief, early post-operative paralysis reduces narcotic dependence without prolonging mechanical ventilation in pediatric abdominal solid organ transplant recipients.