Safety of Maintaining Nutrition Through Moderate Sedation for Burn Wound Care

Abstract

Burn patients often require frequent moderate sedation for burn wound care procedures. The American Society of Anesthesiology recommends patients be made nil per os prior to moderate sedation. Here, we aimed to assess the risk of moderate sedation in burn patients with uninterrupted nutrition. A 12-month single-center retrospective analysis on nonintubated/nontracheostomy burn patients receiving moderate sedation for wound care was performed. A total of 97 moderate sedations were completed on 24 patients. A median of 3 oral premedications and 3 intravenous analgesic/anxiolysis medications per patient were administered during each periprocedural period and achieved a median Richmond Agitation-Sedation Score of -2 (-3, -1). The median of any kind of nutrition was consumed 38 minutes prior to sedations, with a median of 113 minutes from consumption of a full meal. In 32 sedations (33%), patients had tube feeds continued throughout wound care. No complications related to aspiration were noted in any sedation event (97.5% upper Confidence Interval 3.7%), including no episodes of vomiting, evidence of aspiration, pneumonia, hypoxemia, complete airway obstruction, laryngospasm, or death. Hypertension was noted in 17 sedations. Hypotension was noted in 6 sedations. In conclusion, no harmful adverse events were associated with maintained nutrition throughout the peri- and intrasedative wound care periods, including ongoing gastric tube feeds in this small sample of burn patients. These data suggest that uninterrupted nutrition during burn wound care moderate sedation procedures is a safe practice and warrants further study.

Keywords: burn wound care; fasting guidelines; moderate sedation; nutrition.