Experience with procedural sedation in a pediatric burn center

Dawn R. Ebach, Robert P. Foglia, M. Barry Jones, Jacob C. Langer, Michael A. Skinner, Robin Moushey, Lisa Meadows

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background: Burn care requires daily debridement, dressing changes, and assessment 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 procedural sedations (PS) in 220 pediatric burn patients over a 2-year period to identify what influence PS had on patient care. Median patient age was 32 months, and body surface area burn was 7.2% ± 6%. Pharmacological techniques included oral and intravenous medications and N2O. The authors included all sedations given in the burn treatment area and excluded all treatments given in the intensive care unit or emergency unit. Results: PS allowed for early aggressive wound debridement, virtually eliminated the need for operating room debridement (used in only 22 patients), and 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 including decreased arterial saturation (n = 41), emesis (n = 11), and agitation (n = 8). No patient required intubation or transfer to an intensive care 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 intensive care unit. This compares favorably with the 9.5- day LOS of patients treated in 1990. Conclusions: PS in burn patients allows for early aggressive debridement, decreases the use of the operating room for debridement, and a decrease in length of stay when compared with our previous burn patients. PS has a modest 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.

Original languageEnglish (US)
Pages (from-to)955-958
Number of pages4
JournalJournal of Pediatric Surgery
Volume34
Issue number6
DOIs
StatePublished - Jun 1999

Fingerprint

Burn Units
Pediatrics
Debridement
Operating Rooms
Intensive Care Units
Length of Stay
Skin Transplantation
Needs Assessment
Body Surface Area
Wounds and Injuries
Wound Infection
Bandages
Child Care
Intubation
Fear
Vomiting
Hospital Emergency Service
Pneumonia
Patient Care
Pharmacology

Keywords

  • Burns
  • Procedural sedation
  • Wound debridement

ASJC Scopus subject areas

  • Surgery

Cite this

Ebach, D. R., Foglia, R. P., Jones, M. B., Langer, J. C., Skinner, M. A., Moushey, R., & Meadows, L. (1999). Experience with procedural sedation in a pediatric burn center. Journal of Pediatric Surgery, 34(6), 955-958. https://doi.org/10.1016/S0022-3468(99)90767-4

Experience with procedural sedation in a pediatric burn center. / Ebach, Dawn R.; Foglia, Robert P.; Jones, M. Barry; Langer, Jacob C.; Skinner, Michael A.; Moushey, Robin; Meadows, Lisa.

In: Journal of Pediatric Surgery, Vol. 34, No. 6, 06.1999, p. 955-958.

Research output: Contribution to journalArticle

Ebach, DR, Foglia, RP, Jones, MB, Langer, JC, Skinner, MA, Moushey, R & Meadows, L 1999, 'Experience with procedural sedation in a pediatric burn center', Journal of Pediatric Surgery, vol. 34, no. 6, pp. 955-958. https://doi.org/10.1016/S0022-3468(99)90767-4
Ebach DR, Foglia RP, Jones MB, Langer JC, Skinner MA, Moushey R et al. Experience with procedural sedation in a pediatric burn center. Journal of Pediatric Surgery. 1999 Jun;34(6):955-958. https://doi.org/10.1016/S0022-3468(99)90767-4
Ebach, Dawn R. ; Foglia, Robert P. ; Jones, M. Barry ; Langer, Jacob C. ; Skinner, Michael A. ; Moushey, Robin ; Meadows, Lisa. / Experience with procedural sedation in a pediatric burn center. In: Journal of Pediatric Surgery. 1999 ; Vol. 34, No. 6. pp. 955-958.
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abstract = "Background: Burn care requires daily debridement, dressing changes, and assessment 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 procedural sedations (PS) in 220 pediatric burn patients over a 2-year period to identify what influence PS had on patient care. Median patient age was 32 months, and body surface area burn was 7.2{\%} ± 6{\%}. Pharmacological techniques included oral and intravenous medications and N2O. The authors included all sedations given in the burn treatment area and excluded all treatments given in the intensive care unit or emergency unit. Results: PS allowed for early aggressive wound debridement, virtually eliminated the need for operating room debridement (used in only 22 patients), and 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 including decreased arterial saturation (n = 41), emesis (n = 11), and agitation (n = 8). No patient required intubation or transfer to an intensive care 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 intensive care unit. This compares favorably with the 9.5- day LOS of patients treated in 1990. Conclusions: PS in burn patients allows for early aggressive debridement, decreases the use of the operating room for debridement, and a decrease in length of stay when compared with our previous burn patients. PS has a modest 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.",
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