Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, USA.
Expert Rev Neurother. 2010 Nov;10(11):1747-59. doi: 10.1586/ern.10.158.
Standard care of burn wounds consists of cleaning and debridement (removing devitalized tissue), followed by daily dressing changes. Children with burns undergo multiple, painful and anxiety-provoking procedures during wound care and rehabilitation. The goal of procedural sedation is safe and efficacious management of pain and emotional distress, requiring a careful and systematic approach. Achieving the best results needs understanding of the mechanisms of pain and the physiologic changes in burn patients, frequent evaluation and assessment of pain and anxiety, and administration of suitable pharmacological and nonpharmacological therapies. Pharmacological therapies provide the backbone of analgesia and sedation for procedural pain management. Opioids provide excellent pain control, but they must be administered judiciously due to their side effects. Sedative drugs, such as benzodiazepines and propofol, provide excellent sedation, but they must not be used as a substitute for analgesic drugs. Ketamine is increasingly used for analgesia and sedation in children as a single agent or an adjuvant. Nonpharmacological therapies such as virtual reality, relaxation, cartoon viewing, music, massage and hypnosis are necessary components of procedural sedation and analgesia for children. These can be combined with pharmacological techniques and are used to limit the use of drugs (and hence side effects), as well as to improve patient participation and satisfaction. In this article, we review the pathophysiologic changes associated with major thermal injury in children, the options available for sedation and analgesia for wound care procedures in these children and our institutional guidelines for procedural sedation.
烧伤创面的标准治疗包括清洗和清创（去除失活组织），然后进行日常换药。烧伤儿童在创面护理和康复过程中会经历多次痛苦和焦虑的程序。程序镇静的目的是安全有效地管理疼痛和情绪困扰，需要谨慎和系统的方法。要取得最佳效果，需要了解疼痛的机制和烧伤患者的生理变化，频繁评估疼痛和焦虑，并给予适当的药理学和非药理学治疗。
药理学治疗为程序疼痛管理提供了镇痛和镇静的基础。阿片类药物可提供出色的疼痛控制，但由于其副作用，必须谨慎使用。镇静药物，如苯二氮䓬类和丙泊酚，可提供出色的镇静作用，但不能用作镇痛药的替代品。氯胺酮越来越多地作为单一药物或辅助药物用于儿童的镇痛和镇静。非药理学治疗，如虚拟现实、放松、卡通片观看、音乐、按摩和催眠，是儿童程序镇静和镇痛的必要组成部分。这些可以与药理学技术结合使用，以限制药物的使用（从而减少副作用），并提高患者的参与度和满意度。在本文中，我们回顾了与儿童严重热损伤相关的病理生理变化、可用于这些儿童创面护理程序的镇静和镇痛选择以及我们的程序镇静机构指南。
