A 2 year experience of nurse led conscious sedation in paediatric burns

• Published in: Burns 2014-02, Vol.40 (1), p.48-53
• Main Authors: O’Hara, David, Ganeshalingam, Kirubalini, Gerrish, Helen, Richardson, Patricia
• Format: Article
• Language: English
• Subjects: Adolescent; Anesthetics, Dissociative - therapeutic use; Bandages; Burns; Burns - nursing; Burns - therapy; Child; Child, Preschool; Cohort Studies; Conscious sedation; Conscious Sedation - methods; Critical Care; Debridement - methods; Humans; Hypnotics and Sedatives - therapeutic use; Ketamine - therapeutic use; Midazolam - therapeutic use; Nurse led; Paediatric; Pain Management - methods; Pain Measurement; Practice Patterns, Nurses; Retrospective Studies; Treatment Outcome
• ISSN: 0305-4179; 1879-1409
• DOI: 10.1016/j.burns.2013.08.021

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.