Dressings Under Sedation

Airway: Own or LMA
Access: 20G
Pain: Substantial
Position: Variable
Time: Variable
Blood loss: Special:

Change of burns dressings is:

• Performed regularly
• Exquisitely painful
• Often performed out of the operating room if debridement is not required

Considerations

• A
  • Aspiration risk
• B
  • Hypoxia risk under sedation
• D
  • Analgesic requirements
  • Desire of surgical team to wean sedation requirements
• E
  • Extent of burn/time required for dressing change

Process

One approach:

• Induction:
  • 0.5-1mg/kg IV ketamine
    Higher if stimulating.
    • Heavy ketamine use reduces risk of airway obstruction and apnoea
  • 0.05-0.1mg/kg IV oxycodone
• Maintenance
  • Propofol TCI at 1-2ug/ml
  • Consider additional 0.5mg/kg IV ketamine if the procedure is prolonged/stimulating
• Emergence
  • Consider further 0.05mg/kg oxycodone for post-operative analgesia

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