Reviewing the Safety of Providing Out of Operating Room Anesthesia for Acute Burns in Pediatric Patients

Pain management is a cornerstone of acute pediatric burn care, and burn wound care frequently requires sedation or anesthesia to optimize patient comfort and procedural success. Anesthesia delivered outside of the operating room (OR) has been shown to be a safe and effective alternative to OR-based care; however, eligibility has traditionally been restricted to older and larger children. Following a quality care audit in 2022, eligibility for anesthesiologist-administered out-of-OR anesthesia at our tertiary pediatric burn center was expanded to include children aged 8-12 months and/or weighing 8-10 kg. The objective of this study was to compare key quality and safety indicators between patients meeting expanded eligibility criteria and those meeting historical criteria (>10 kg and/or 12-24 months) undergoing burn dressing changes in a general anesthesia-ready satellite anesthesia room. This single-center retrospective study included patients treated between January 2022 and January 2024. Outcomes included procedure duration, anesthetic technique, airway management, anesthesia-related complications, and post-procedure disposition. A total of 211 patients undergoing 296 procedures were included. Burn characteristics were similar between groups, with scald injuries and partial-thickness burns predominating. No episodes of oxygen desaturation, hemodynamic instability, airway obstruction, or difficult mask ventilation were observed. One episode of laryngospasm occurred in the expanded group and resolved with conservative airway management. Procedure duration was shorter, while time to discharge was slightly longer, in the expanded group. These findings suggest that expanding eligibility criteria for out-of-OR anesthesia in pediatric burn patients is safe and feasible and does not compromise procedural efficiency or outcomes.