title: Efficacy and safety of procedural sedation and analgesia for burn wound care.
abstract: The study aim was to quantify efficacy and patient safety of registered nurse-administered procedural sedation and analgesia in a regional burn center. The investigators conducted a review of procedural sedation forms for all pediatric and adult patients admitted to this burn center from January 1, 2005, through December 31, 2005, for demographic and clinical data including patient age, gender, body weight, TBSA, dates of burn injury and wound care procedures, length of procedure, pre- and postprocedural pain assessment, procedural sedation/analgesia medications and doses, adverse drug events, and related interventions. During the 12-month study period, a total of 328 burn patients received 1293 procedural sedation procedures; child subjects (≤ 18 years) received 356 procedures and adult subjects (19-87 years) received 937 procedures. The mean (SD) length of the procedure was 60.1 (22.49) minutes with a range of 10 to 170 minutes. The mean subject age was 34.2 years (range: 6 weeks to 87 years), 67% were male, and the mean TBSA was 17% (0.5-68%). Ninety-four percent received fentanyl for analgesia and 85% received midazolam for anxiolysis and amnesia. The mean preprocedural pain score was 3.2 and the mean postprocedural pain score was 2 (t = 14.795; df = 1243; P < .001). Ten adverse events, all respiratory related, were documented in eight patients, two of whom experienced a second adverse event for an overall adverse event rate of 0.77%. No patient required intubation. Procedural sedation administered by a registered nurse competent in administration and monitoring in a burn center provided safe and effective pain management during wound care.
authors.affiliation: Paul and Carol David Foundation Burn Institute, Akron Children's Hospital, Akron, Ohio 44308, USA.
authors.forename: Elaine M
authors.initials: EM
authors.lastname: Thompson
authors.forename: David D
authors.initials: DD
authors.lastname: Andrews
authors.forename: Cheryl
authors.initials: C
authors.lastname: Christ-Libertin
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000698:Analgesia / Q000379:methods*; D002053:Burn Units; D002056:Burns / Q000175:diagnosis / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016292:Procedural Sedation / Q000379:methods*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D015601:Injury Severity Score; D008297:Male; D008874:Midazolam / Q000008:administration & dosage; D008875:Middle Aged; D010147:Pain Measurement / Q000187:drug effects*; D018570:Risk Assessment; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D006993:Hypnotics and Sedatives; D008874:Midazolam; D005283:Fentanyl