Journal of burn care & research : official publication of the American Burn Association
-
Randomized Controlled Trial Comparative Study
Ketamine-propofol vs ketamine-dexmedetomidine combinations in pediatric patients undergoing burn dressing changes.
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. ⋯ 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.
-
The treatment of pain produced during the management of burn injury has been an ongoing problem for physicians caring for these patients. The main therapeutic option for analgesia has been the repeated and prolonged use of opioids. The adverse effects of opioids are well known but the long term use of opioids which produces tolerance with accompanying dose escalation and dependence is most problematic. ⋯ This syndrome is manifest as enhanced pain, sensitivity and loss of analgesic efficacy in patients treated with opioids who actually become sensitized to painful stimuli. This article focuses on the treatment of burn pain and how current analgesic therapies with opioids may cause hyperalgesia and affect the adequacy of treatment for burn pain. This article also provides possible modalities to help therapeutically manage these patients and considers future analgesic strategies which may help to improve pain management in this complicated patient population.
-
This review article examines the use of human albumin (HA) in burn treatment. Generally, there are two scenarios where HA may be administered: acutely as a volume expander during burn shock resuscitation and chronically following resuscitation to correct hypoalbuminemia. Although colloids were the cornerstone of the earliest burn resuscitation formulas, HA was in fact rarely used. ⋯ Maintenance of normal serum ALB levels through continuous supplementation of HA following burn resuscitation is even less well understood. Although this approach makes physiologic sense, the limited amount of available data from human burn studies reveal that chronic ALB supplementation is expensive and may not result in any major clinical benefits. Again, modernized prospective studies are greatly needed in this area.
-
Vitamin D deficiency has been reported in pediatric burn patients; however, no formal studies have been conducted in adult burn populations. The available literature on vitamin D status in burn patients has been reviewed. A literature search was conducted using Medline™, the Cochrane central register of controlled trials, and EMBASE to identify any trials of vitamin D deficiency in burn patients. ⋯ Population groups are at higher risk of vitamin D deficiency if they have inadequate exposure to UV light or reduced biosynthetic capability due to skin damage. Burn patients fall into both risk groups and also suffer common complaints that overlap with those reported by patients with vitamin D deficiency. Further research in adult burn patients is needed to determine the prevalence of deficiency in this population and whether vitamin D deficiency might influence postburn injury symptoms reported by patients.
-
Toxic epidermal necrolysis (TEN) represents the most severe drug-related skin condition that is potentially life-threatening with no well-established treatments. The application of corticosteroid therapy is controversial, whereas recently intravenous immunoglobulin (IVIG) therapy is emerging as a promising new method. A severity-of-illness score for TEN (SCORTEN) has gained acceptance in some western countries. ⋯ Compared with corticosteroid alone, the combination therapy arrested progression earlier (P = .013), although it did not significantly lead to a tapering of corticosteroid or a reduction of the time of hospitalization. We concluded that SCORTEN was generally applicable to Chinese patients with TEN. The comparison of the effect indicated that the combination therapy might achieve a better therapeutic effect than the administration of corticosteroid alone, especially in severe TEN patients.