Considerations for pediatric burn sedation and analgesia

Fagin, Alice; Palmieri, Tina L

doi:10.1186/s41038-017-0094-8

Cited by 32 publications

(35 citation statements)

References 61 publications

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“…133 Currently, despite recognised shortcomings, standardised pathways are probably still the best approach available. 134 Pain management in burn-injured patients remains challenging despite our increased understanding of the mechanisms involved in the various phases of recovery, and our understanding of the chronification of pain, and the effect of pain and suffering on the long-term outcomes for the burn patient.…”

Section: Challenges Of Managing Burn Painmentioning

confidence: 99%

Challenges in anaesthesia and pain management for burn injuries

Stapelberg

2020

Anaesth Intensive Care

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Burn-injured patients provide unique challenges to those providing anaesthesia and pain management. This review aims to update both the regular burn anaesthetist and the anaesthetist only occasionally involved with burn patients in emergency settings. It addresses some aspects of care that are perhaps contentious in terms of airway management, fluid resuscitation, transfusion practices and pharmacology. Recognition of pain management failures and the lack of mechanism-specific analgesics are discussed along with the opioid crisis as it relates to burns and nonpharmacological methods in the management of distressed patients.

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Section: Challenges Of Managing Burn Painmentioning

confidence: 99%

Challenges in anaesthesia and pain management for burn injuries

Stapelberg

2020

Anaesth Intensive Care

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“…Despite this, pain control remains inadequate, not only in the sub-Saharan region but across the globe. 2,3,4,5 Adequate analgesia in burns is essential, but it is often difficult to achieve. Additionally, burn pain is dynamic and needs constant reassessment by medical practitioners.…”

Section: Introductionmentioning

confidence: 99%

Reaching consensus on an analgesia protocol for paediatric burn patients in a resource-scarce South African community

Wall

Allorto

Chetty

2021

South African Family Practice

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Background: Despite the exceptional burden of burns in low- and middle-income countries (LMIC) and the importance of adequate analgesia in burn care, there is a lack of analgesia protocol developed in resource-scarce settings. This necessitates the development of an analgesia protocol applicable to the resource-scarce setting. This study presents the findings of a modified Delphi study aimed at achieving consensus by a panel of experts in the management of burn injuries from low- and middle-income settings across Africa.Methods: A two-round Delphi survey was conducted to achieve consensus on an analgesia protocol for paediatric burn patients for a resource-limited setting. The Delphi panel consisted of nine experts with experience in management of burn injuries in low-income settings.Results: Consensus was determined by an a priori threshold of 80% of agreement for a drug to be included in the analgesia protocol. There was a largely overarching agreement with regard to the background analgesia protocol and strong agreement regarding the use of an initial dose of ketamine and midazolam for procedural sedation.Conclusion: A modified Delphi method was used to obtain expert consensus for a recently adopted analgesia protocol for burn-injured children in a resource-limited setting, with experts in the management of burn injuries in low- and middle-income settings. The expert consensus leads to the rigour and robustness of the protocol. Delphi methods are exceptionally valuable in healthcare research and the aim of such studies is to find converging expert opinions.

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“…Procedural analgesia and sedation are of paramount importance to reduce pain and anxiety ensuring early and extensive debridement, when needed, which will allow for improved healing as well as preventing fear of future procedures when it is given appropriately. [6][7][8][9] Procedural sedation has become the standard of care in both inpatient and outpatient settings, however, many practices are not yet evidence-based due to a lack of well-designed studies. 10,11 Many agents have been tried alone and in combination but there is no consensus on procedural sedation in children.…”

Section: Introductionmentioning

confidence: 99%

“…[10][11][12] Numerous factors need to be considered when choosing an agent including the age and weight of the child; the location, depth and extent of the burn and the length of the procedure itself. 6,7 Methoxyflurane (MF) is a volatile anaesthetic agent. Historically it was used as an inhalational agent for general anaesthesia but was discontinued due to nephrotoxicity in a dose dependent manner, the upper limit of safety now suggested as 2 Minimum Alveolar Concentration (MAC)-hours.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of inhaled methoxyflurane for procedural analgesia in paediatric burns: a pilot study

Wellbeloved

Parkhurst

Keeling

2020

South Afr J Anaesth Analg

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Background: Methoxyflurane (MF), a volatile anaesthetic agent is known for its analgesic properties in sub anaesthetic concentrations. It has been used as an analgesic agent for short procedures in both adults and children in the prehospital setting and in the emergency department. We conducted a pilot study to investigate the use of MF for burn dressing changes in children. Methods: A prospective case series was conducted in the paediatric burns ward amongst children aged 4–9 years. During burns dressing changes MF was administered using a hand-held patient-controlled device. An investigator monitored vital signs together with pain scores, sedation levels and levels of satisfaction of staff. Results: Twelve patients were enrolled for the study. The majority of the burn wounds were classified as partial-thickness wounds. Methoxyflurane was used as the sole agent for analgesia and sedation for the procedure. No major adverse events were noted. Analgesia and sedation levels were sufficient and appropriate respectively for the majority of the patients during the initial exposure of the wound and the application of the new dressing. However, during the scrubbing of the burn wound analgesia and sedation proved insufficient in four and seven of the patients respectively. Conclusion: In our setting the use of MF for inpatient burn wound dressing changes may be insufficient as a sole agent in the paediatric patient. We suggest it may be used as an adjunct to current practice. Further, larger studies are required to delineate the appropriate role MF can play in the paediatric burns setting.

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Considerations for pediatric burn sedation and analgesia

Cited by 32 publications

References 61 publications

Challenges in anaesthesia and pain management for burn injuries

Challenges in anaesthesia and pain management for burn injuries

Reaching consensus on an analgesia protocol for paediatric burn patients in a resource-scarce South African community

Efficacy of inhaled methoxyflurane for procedural analgesia in paediatric burns: a pilot study

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