712 Title: Monitored Anesthesia Care (MAC) Burn Dressing Changes Even in Critically Ill Patients Is Incredibly Safe

Abstract

Abstract Introduction Objective: Identify prevalence and factors associated with hypoxia and blood pressure changes during MAC anesthesia for inpatient burn dressing change. Methods Retrospective chart review on 112 adult inpatients undergoing 1 or more burn dressing changes under MAC from March 2014 to December 2017 at a single burn center. Results Study population was 112 burn inpatients undergoing 210 burn dressing changes under MAC. Median age was 43 years (range 18–93) with 78% male and 95% Caucasian. Average BMI was 29.7 (range 18–66). Average % total body surface area (TBSA) burn was 24% (range 1%-70%). Number of MAC dressing changes per patient was 1 to 16 with most (71.4%) undergoing 1 MAC dressing change. Among 210 MAC cases, 5 involved a hypoxemic event (defined as a % O2 saturation of < 90%) and 14 involved a blood pressure changed (defined as a mean arterial pressure (MAP) of < 60 mmHg) on 7 different patients Three of the hypoxic events were also associated with hypotension (1.4%) None of these events were associated with poor outcomes. Conclusions MAC anesthesia for dressing changes are performed on inpatients during all stages of the burn recovery. Anesthesia is involved with the initial dressing changes on the critical care individuals. The MAC anesthesia is titrated to the condition of the patient with very low frequency of hypoxia or severe hypotension. Applicability of Research to Practice Burn dressing changes are challenging anesthesias because of the often associated co-morbidities of the presenting patients. Other factors that are considered are the NPO status and nutritional requirements of the patients. The desire to accomplish the dressing changes with the least amount of disruption of this while caring for these ill patients can be safely accomplished with MAC dressing changes. This provides an incredibly safe environment for the patient with the rapidly titratable medications that allow the dressing changes to be completed efficiently.