Safety and Adverse Event Profile of Procedural Sedation for Pediatric Burn Wound Care: A Single-Center Retrospective Cohort Study

Abstract Procedural sedation is essential for pediatric burn care, yet standardized, evidence-based regimens are lacking. This study characterizes the safety profile and pharmacological predictors of adverse events (AEs) in intensivist-led pediatric burn sedations. We conducted a retrospective cohort study of 626 procedural sedations across 208 pediatric burn patients at a single tertiary pediatric intensive care unit (PICU) from 2016 to 2025. Sedations were evaluated for medication exposure, burn severity, and clinical outcomes. A generalized estimating equation (GEE) logistic regression model, adjusting for patient demographics, burn severity, and repeated encounters, was utilized to identify independent predictors of AEs. The median patient age was 3 years, with a median total body surface area burned of 5%. The overall AE rate was 13.1%, predominantly consisting of transient respiratory events, including oxygen desaturation (9.1%) and airway obstruction (8.1%). There were zero serious AEs, such as unplanned intubations or death. Multi-drug regimens were utilized in 79.9% of encounters. In multivariable analysis, both propofol use (OR 5.10, 95% CI 2.22–11.75, p<0.001) and ketamine use (OR 2.64, 95% CI 1.19–5.89, p=0.018) were independent predictors of AEs, even after adjusting for baseline case complexity and burn severity. Pediatric critical care physician-led procedural sedation for pediatric burn wound care is safe, with zero serious adverse events observed over a 9-year period. While propofol and ketamine are both independently associated with transient respiratory events, propofol exhibits a strict dose-dependent risk whereas ketamine's risk is dose-independent. Both require vigilance, but these predictable risk profiles allow for highly individualized, bedside risk-stratification.