David O'Hara1, Kirubalini Ganeshalingam2, Helen Gerrish2, Patricia Richardson2. 1. St Andrew's Centre for Plastic Surgery and Burns, Chelmsford, Essex, United Kingdom. Electronic address: oharainnz@yahoo.com. 2. St Andrew's Centre for Plastic Surgery and Burns, Chelmsford, Essex, United Kingdom.
Abstract
INTRODUCTION: Ketamine and midazolam have been used safely by anaesthetists in paediatric burns and have a good safety profile. We believed that this could be developed to a nurse led conscious sedation protocol, without direct anaesthetic attendance. METHODS: Two years experience of our technique was retrospectively reviewed. We recorded the age, weight, percentage burn, dose of oral ketamine and midazolam given, time for procedure whether an anaesthetist was called to the sedation room, and the reason for the call. RESULTS: Data were collected for a total of 45 children undergoing 131 procedures. The age (mean ± SD) was 9.5 ± 4.7 years, the weight (mean ± SD) 38.7 ± 19.8 kg and the percentage burn (mean ± SD) was 25.3 ± 22.9%. The dose of oral ketamine (mean ± SD) was 409.5 ± 252.3mg or 8.78 ± 3.27 mg/kg and the dose of oral midazolam (mean ± SD) was 17.6 ± 8.7 mg or 0.44 ± 0.14 mg/kg. The duration of procedure (mean ± SD) was 97.32 ± 32.90 min. The incidence of the anaesthetist required to administer further sedation was 29.8% of sedations. The decision to convert to general anaesthesia was taken in 2.3% of cases. An anaesthetist was called other than to top up sedation in 6.9% of sedations. CONCLUSION: Our protocol for nurse-monitored conscious sedation using oral ketamine and midazolam in the burns patient provides a safe method of analgesic sedation for burn dressing changes.
INTRODUCTION:Ketamine and midazolam have been used safely by anaesthetists in paediatric burns and have a good safety profile. We believed that this could be developed to a nurse led conscious sedation protocol, without direct anaesthetic attendance. METHODS: Two years experience of our technique was retrospectively reviewed. We recorded the age, weight, percentage burn, dose of oral ketamine and midazolam given, time for procedure whether an anaesthetist was called to the sedation room, and the reason for the call. RESULTS: Data were collected for a total of 45 children undergoing 131 procedures. The age (mean ± SD) was 9.5 ± 4.7 years, the weight (mean ± SD) 38.7 ± 19.8 kg and the percentage burn (mean ± SD) was 25.3 ± 22.9%. The dose of oral ketamine (mean ± SD) was 409.5 ± 252.3mg or 8.78 ± 3.27 mg/kg and the dose of oral midazolam (mean ± SD) was 17.6 ± 8.7 mg or 0.44 ± 0.14 mg/kg. The duration of procedure (mean ± SD) was 97.32 ± 32.90 min. The incidence of the anaesthetist required to administer further sedation was 29.8% of sedations. The decision to convert to general anaesthesia was taken in 2.3% of cases. An anaesthetist was called other than to top up sedation in 6.9% of sedations. CONCLUSION: Our protocol for nurse-monitored conscious sedation using oral ketamine and midazolam in the burns patient provides a safe method of analgesic sedation for burn dressing changes.
Authors: Helmut Trimmel; Raimund Helbok; Thomas Staudinger; Wolfgang Jaksch; Brigitte Messerer; Herbert Schöchl; Rudolf Likar Journal: Wien Klin Wochenschr Date: 2018-01-10 Impact factor: 1.704