No abstract

The aim of this study was to compare ketamine-propofol (KP) and ketamine-dexmedetomidine (KD) combinations for deep sedation and analgesia during pediatric burn wound dressing changes. After obtaining approval from the University Ethics Committee, burn wound care or wound dressing changes were performed on 60 American Society of Anesthesiologists physical status I and II inpatients aged between 8 and 60 months with second-degree burns ranging from 5 to 25% TBSA. After recording the demographic data, the heart rate, systolic arterial pressure, diastolic arterial pressure, peripheral oxygen saturation, respiratory rate, and Ramsey sedation scores were recorded for all patients before and during the procedure. Group KP (n = 30) received 1 mg kg⁻¹ ketamine + 1 mg kg⁻¹ propofol and group KD (n = 30) received 1 mg kg⁻¹ ketamine + 0.5 μg kg⁻¹ dexmedetomidine for induction. Additional propofol (1 mg kg⁻¹) for group KP and additional dexmedetomidine (0.5 μg kg⁻¹) for group KD were administered when required. No statistically significant differences in sedation scores and peripheral oxygen saturation and diastolic arterial pressure (P > .05) were found between the two groups. However, systolic blood pressure values in group KD showed a significant increase after induction (P < .05). The recovery time was longer in group KD than in group KP (P < .05). The respiratory rate was higher in group KD than in group KP beginning from the fifth minute of the procedure. A significant amount of respiratory depression and hypoxia was observed in group KP but not in KD (P < .05). Both the KP and KD combinations were effective for sedation and analgesia during dressing changes in the pediatric burn patients. The KD combination can be considered as an excellent alternative for pediatric wound dressing changes which does not result in respiratory depression.

To evaluate the risk factors for nosocomial infection (NI) and mortality in a university hospital, 10-year data of burn patients were assessed retrospectively. The study was conducted at Erciyes University's Burn Center during 2000 and 2009. The records of 1190 patients were obtained. Overall, 131 (11%) patients had 206 NIs with an incidence density of 14.7 infections/1000 patient days. Burn wound infection (n = 109, 53%) was the most common NI. High (%TBSA burned) and late excision were found to be the most significant risk factors for the development of NI. Pseudomonas aeruginosa was the most frequent causative microorganism. However, the prevalence of multidrug-resistant Acinetobacter baumannii has increased in recent years with a prevalence of 47% in 2009. The carbapenem resistance of P. aeruginosa has decreased in recent years, whereas that of A. baumannii increased and it had a prevalence of 94% in the last year. Conversely, the most important risk factors for mortality were advanced age, high %TBSA and having an underlying disease. Prevention of NI is an important issue in burn units to reduce mortality rates. Early excision and wound closure are important therapeutic approaches for the prevention of burn wound infection.

As in many other countries, burn injuries are a challenging healthcare problem in Turkey. Initial management of burn patients is very important for future morbidity and mortality. Therefore, the Turkish Ministry of Health prepared "National Burns Treatment Algorithm" aided by the Scientific Burns Council. The basic aim of this algorithm is to guide physicians in the treatment of burn victims until they reach an experienced burns center. The content of this algorithm is first aid, initial management, resuscitation, and transfer policy. The Council started to work on this algorithm in 2011. Various consultants, including general surgeons, pediatric surgeons, aesthetic, plastic and reconstructive surgeons, anesthesiologists, and intensive care physicians, revised the first draft and it was sent to eight education and research hospitals of the Ministry of Health, four universities, and seven non-governmental organizations. In the last quarter of 2012, the algorithm was finalized and approved by the Scientific Council, after which, it was approved by the Ministry of Health and published.

Both propofol-ketamine and propofol-fentanyl combinations provided effective sedation and analgesia during dressing changes in pediatric burn patients. But propofol-ketamine combination was superior to propofol-fentanyl combination because of more restlessness in patients given propofol-fentanyl.