title: A 2 year experience of nurse led conscious sedation in paediatric burns.
abstract: BACKGROUND
  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.
  
  
  CONCLUSIONS
  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.affiliation: St Andrew's Centre for Plastic Surgery and Burns, Chelmsford, Essex, United Kingdom. Electronic address: oharainnz@yahoo.com.
authors.forename: David
authors.initials: D
authors.lastname: O'Hara
authors.affiliation: St Andrew's Centre for Plastic Surgery and Burns, Chelmsford, Essex, United Kingdom.
authors.forename: Kirubalini
authors.initials: K
authors.lastname: Ganeshalingam
authors.affiliation: St Andrew's Centre for Plastic Surgery and Burns, Chelmsford, Essex, United Kingdom.
authors.forename: Helen
authors.initials: H
authors.lastname: Gerrish
authors.affiliation: St Andrew's Centre for Plastic Surgery and Burns, Chelmsford, Essex, United Kingdom.
authors.forename: Patricia
authors.initials: P
authors.lastname: Richardson
mesh_terms: D000293:Adolescent; D000778:Anesthetics, Dissociative / Q000627:therapeutic use*; D001458:Bandages; D002056:Burns / Q000451:nursing* / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016292:Procedural Sedation / Q000379:methods*; D003646:Debridement / Q000379:methods; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D007649:Ketamine / Q000627:therapeutic use*; D008874:Midazolam / Q000627:therapeutic use*; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D057184:Practice Patterns, Nurses'; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000778:Anesthetics, Dissociative; D006993:Hypnotics and Sedatives; D007649:Ketamine; D008874:Midazolam
keywords: Burns; Conscious sedation; Nurse led; Paediatric