Monitored Anesthesia For Major Burn Dressings, oral presentation by Dr Ali Mujtaba in PAPSCON 2023 at Quied e azam medical college (QMC), Victoria hospital, Bahawalpur, Punjab, Pakistan Dr Ali Mujtaba Post-graduate Resident surgeon MS Burns and Reconstructive surgery Burn Care Centre Supervisor: Prof Tariq Iqbal Shaheed Zulfiqar Ali Bhutto Medical University (SZABMU) Pakistan institute of medical sciences (PIMS) Islamabad, Pakistan Alimujtaba86@gmail.com

1. PAPSCON 2023
Monitored Anesthesia For Major Burn Dressings
Dr. Ali Mujtaba
Post-graduate Resident
MS BurnsReconstructive Surgery
Burn Care Centre
SZABMU, PIMS, Islamabad

2. Monitored Anesthesia For Major Burn Dressings
Dr.
Ali Mujtaba
Post-
graduate Resident
MS Burns &
Reconstructive Surgery

3. Definition
• Monitored anesthesia is administering a combination of drugs for
anxiolytic, hypnotic, amnestic, and analgesic effect.

4. ASA Definition
• According to the American Society of Anesthe-siologists (ASA), a
monitored anesthesia is a planned procedure during which the
patient undergoes local anesthesia together with sedation and
analgesia.

5. What is monitored anesthesia care?
Monitored anesthesia care (MAC) is a type of anesthesia in which an
anesthesiologist:
• Continously monitor and support the patient's vital functions.
• Diagnose and treat clinical problems that occur.
• Administer sedative, anxiolytic, or analgesic if needed.
• Converts to general anesthesia if required.

6. Conscious Sedation
• Minimal depressed level of consciousness that retain the patient's
ability to independently and continuously maintain an airway and
respond appropriately to physical stimulation and verbal
command.

7. Con.
There are 3 fundamental purposes of a conscious sedation during MA
:
• Safe sedation.
• Control of the patient anxiety.
• Pain control.

8. Monitored Anesthesia In Acute Burn
• Acute burn dressing change is painful, especially when large
surface area is involved.
• Trauma of multiple dressings develop reluctance to dressing
change in acute major burn patients.
• Background pain, procedural pain, breakthrough pain
• Relaxation of body for MUA/FRM

9. Study Material & Design
Retrospective study was carried out from 2011 to 2022 in Burn center,
PIMS, Islamabad
The study aimed at
• Calculating the efficacy of the drugs used.
• Effects of drugs in post-operative period.
• Any known complications.

10. Cont:
• Data includes 21,349 patients underwent dressing change under
monitored anesthesia in last 10 years
• Patients wounds & body were thoroughly washed.
• Full Range Manipulation (FRM), debridements under anesthesia and
then dressing done.
• All the anesthesia logs and post op status of patients were assessed.

11. Anesthesia Drugs
Drugs used were:
Ketamine (Low-dose 0.5-1mg/kg)
Propofol (Initial bolus 0.5mg/kg then 10mg intermittent bolus)
Nalbuphine (0.1mg/kg)
Midazolam (1-2mg before propofol)
Paracetamol (10-15mgg/kg)

12. Results
• 45% female and 55% male patients underwent monitored
anesthesia.
• Average age of the patient was 12.6 years.
• Mean TBSA for which burn dressings were done, was 34.3%.
• Anesthesia recovery time was 1 hour.

13. Cont.
• 95% of the patients experienced no pain,after the dressing
change.
• 3% of the patients had experienced delusions.
• 17% developed hemodynamic instability.
• 0.8% developed hypoxia during dressings.

14. Goals..
• To maintain patient safety & sense of well being
• Alleviate pain
• Minimise discomfort
• Minimise psychological response
anxiolysis, analgesia, amnesia
• To return to pre-procedural state
recognised criteria
to practice day care case burn dressing

16. Conclusions
Monitored anesthesia for dressing change, performed on in-patients and
out-patients during all stages of the burn recovery:
• Required minimal anesthesia.
• Early post anesthesia recovery.
• Can be practice in Minor OTs.

17. Thank you