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Pain is an important contributing factor to the prognosis of critically ill patient. This review will focus on dealing with
sedation and analgesia for a critically ill pediatric patient at different stages in the management of respiratory failure. The
child at this level of severe illness is not only suffering from pain due to the underlying disorder, but also anxiety because of
what is going to happen in such unusual environment and surroundings. The patient is in need for effective but save sedation
and analgesia, accordingly selecting the appropriate drug among different agents is important, however, sometimes it is not
easy to accomplish such objectives without securing the airway and mechanical ventilation. Even at post intubation and
mechanical ventilation stage, several considerations needed in managing the pain and anxiety, the clinicians need to always
remember that stopping patient’s movement by muscle relaxants never treat pain or anxiety rather it increases the anxiety and
more suffering without adequate sedation and analgesia. Similarly, sedation alone in painful procedures is not enough. Of para
amount importance, in such situation it is important to have a protocol to assess the existence and severity in the absence of
self-reported pain with more challenges if the patient is paralyzed. Then tailoring the pain and anxiety management to the
patient’s need while avoiding over tenement, not only because of possible immediate complications but also because of the
withdrawal manifestation which need to be taken in consideration by preventive measures during therapy and effectively
looked for and managed post-extubation and discontinuation of analgesic and sedative agents. The important messages are to
ensure adequate but safe sedation and analgesia at different stages of the patient’s status, which requires adequate knowledge
and skills in pain assessment in such challenging situations.