Experience with procedural sedation in a pediatric burn center

Background: Burn care requires daily debridement, dressing changes, and ass essment regarding the need for skin grafting. These procedures are painful and may require an operating room environment. Methods: The authors reviewed their experience with 912 consecutive procedu ral sedations (PS) in 220 pediatric burn patients over a 2-year period to i dentify what influence PS had on patient care. Median patient age was 32 mo nths, and body surface area burn was 7.2% +/- 6%. Pharmacological technique s included oral and intravenous medications and N2O. The authors included a ll sedations given in the burn treatment area and excluded all treatments g iven in the intensive care unit or emergency unit. Results: PS allowed for early aggressive wound debridement, virtually elimi nated the need for operating room debridement (used in only 22 patients), a nd eliminated patient discomfort and fear often associated with subsequent debridements. Burn wound-related complications occurred in 54 patients and included wound infection (n = 18), graft loss (n = 9), and pneumonia (n = 4 ). The incidence of PS complications was 7% with the most common problems i ncluding decreased arterial saturation (n = 41), emesis (n = 11), and agita tion (n = 8). No patient required intubation or transfer to an intensive ca re unit bed. The average length of stay (LOS) for all patients was 8.7 +/- 6.2 days, and 6.2 +/- 3.8 days in the 200 patients not admitted to the inte nsive care unit. This compares favorably with the 9.5-day LOS of patients t reated in 1990. Conclusions: PS in burn patients allows for early aggressive debridement, d ecreases the use of the operating room for debridement, and a decrease in l ength of stay when compared with our previous burn patients. PS has a modes t risk of complications, enhances the family's cooperation and satisfaction with health care provided, and should be an integral part of burn care in children. J Pediatr Surg 34:955-958. Copyright (C) 1999 by W.B. Saunders Co mpany.