During the first four hours of ICU admission the patients will be assessed hourly via the Modified Motor Activity Assessment Scale (MMAAS, see appendix 1). Adjustments will be made to Fentanyl and Midazolam infusions according to protocol for patients not achieving a sedation score of –1 to +1 (see figure 1). Patients with score of greater than +1 and associated tachycardia/hypertension will receive a bolus of Fentanyl and repeat MMAAS in 30 minutes. The Fentanyl bolus will be equal to one hour total dose of Fentanyl infusion with considerations for weight. Dosage will be adjusted for weight accordingly: 1mcg/kg for children less than 50kg and 0.5mcg/kg for children greater than 50kg. If repeat MMAAS score is again greater than +1 with hypertension/tachycardia the patient will receive another bolus of Fentanyl (dose as denoted above) and will have increase of Fentanyl infusion by 1mcg/kg/hr. The patient will have repeat MMAAS 30 minutes after change. If repeat MMAAS score still greater than +1 a physician will be called for assessment and intervention. If the first repeat MMAAS score is greater than +1 with no hypertension/tachycardia the patient will receive a bolus of Midazolam. The Midazolam bolus will be either equal to one hour total dose of Midazolam infusion or 0.1mg/kg with considerations for weight. Dosage will be adjusted according for weight: 0.1mg/kg for children less than 20kg or 0.05mg/kg for children greater than 20kg. The patient will have repeat MMAAS in 30 minutes. If second MMAAS score still greater than +1 a physician will be called for assessment and intervention. If MMAAS score at any time between +1 and –1 then repeat MMAAS will be repeated at next scheduled time per protocol (see figure 2).