Hansen Jennifer K, Voss Jordan, Ganatra Hammad, Langner Travis, Chalise Prabhakar, Stokes Shaun, Bhavsar Dhaval, Kovac Anthony L
Department of Anesthesiology, University of Kansas Medical Center, Kansas City.
School of Medicine, University of Kansas Medical Center, Kansas City.
J Burn Care Res. 2019 Apr 26;40(3):287-293. doi: 10.1093/jbcr/irz023.
Sedation practices for pediatric burn patients during dressing changes vary between institutions and providers. To better understand the current trends in pediatric sedation practice, a survey was conducted among the members of the American Burn Association (ABA). Questions asked about nonoperating room sedation and analgesia practices for burn patients (ages 0-17) having dressing changes in the intensive care unit, inpatient unit, and outpatient clinics. ABA members providing sedation for pediatric patients undergoing burn dressing changes are diverse. Physician respondents included surgeons, critical care intensivists, and anesthesiologists. Others included physician assistants, nurse anesthetists, nurse practitioners, and sedation credentialed nurses. Opioids for pain control were prescribed by 100% of respondents, but use of adjuvant nonopioid analgesics was utilized <50% of the time. Benzodiazepines and ketamine were prescribed more than twice as often as other sedatives. Many noted that up to 50% of children did not have adequately controlled anxiety and pain with initial sedation plans, and escalation of care was needed to complete dressing changes. Self-reported adverse events were infrequent. In outpatient settings, benzodiazepines, ketamine, oral opioids, and topical lidocaine were used frequently, as were nonpharmacologic methods of distraction and comfort. Sedation in pediatric burn patients is challenging. Responses highlighted areas for improvement regarding pain control during dressing changes and increasing use of multimodal analgesia. Commonly used medications including opioids, benzodiazepine, and ketamine are well established in the treatment of burn patients, as are nonpharmacologic methods. A collaborative effort among institutions is needed to formulate practice guidelines for sedation during burn dressing changes.
儿科烧伤患者换药期间的镇静方法在不同机构和医护人员之间存在差异。为了更好地了解儿科镇静实践的当前趋势，对美国烧伤协会（ABA）的成员进行了一项调查。问题涉及重症监护病房、住院部和门诊诊所中0至17岁烧伤患者换药时的非手术室镇静和镇痛方法。为接受烧伤换药的儿科患者提供镇静的ABA成员多种多样。回答问题的医生包括外科医生、重症监护专家和麻醉医生。其他人员包括医师助理、麻醉护士、执业护士和具有镇静资质的护士。100%的受访者会开具阿片类药物用于控制疼痛，但辅助性非阿片类镇痛药的使用时间不到50%。苯二氮䓬类药物和氯胺酮的处方频率是其他镇静剂的两倍多。许多人指出，高达50%的儿童在初始镇静方案下焦虑和疼痛未得到充分控制，需要加强护理以完成换药。自我报告的不良事件很少见。在门诊环境中，苯二氮䓬类药物、氯胺酮、口服阿片类药物和局部利多卡因经常使用，非药物性的分散注意力和安抚方法也经常使用。儿科烧伤患者的镇静具有挑战性。回答突出了换药期间疼痛控制以及增加多模式镇痛使用方面需要改进的领域。常用药物包括阿片类药物、苯二氮䓬类药物和氯胺酮，在烧伤患者治疗中已得到广泛应用，非药物方法也是如此。各机构之间需要共同努力制定烧伤换药期间的镇静实践指南。
