Non-Pain Symptoms
Excessive Secretions:
Excessive secretions or difficulty clearing pharyngeal secretions may lead to noisy or “rattly” breathing.
This commonly occurs during the terminal phase of the child’s illness and is often associated with decreased consciousness.
This symptom should be explained to the family, because it can be very distressing (5).
Treatment:
Non pharmacological:
- Positioning and suctioning can help to decrease the noise.
Pharmacological
Anticholinergics
- Anticholinergics are useful to dry secretions and reduce secretions production.
- The main difference between glycopyrrolate and scopolamine is that glycopyrrolate does not cross the blood brain barrier producing less CNS effects as sedation.
Commonly Used doses:
- Glycopirrolate IV/SC 5-10 mcg/kg TID. PO 20-40 mcg/kg TID
- Scopolamine IV/SC 5-10 mcg/kg TID. Patch 1 mg patch every 72 hrs
