Anesthetic management of burn patients requires the application of a wide range of knowledge as it relates to the pathophysiology of burn patients. Some of the important points include: Ocular: Ocular involvement associated with inhalation injuries; use lubricants to avoid corneal abrasion. Cutaneous: Blood pressure may decrease during excision and grafting caused by release of vasodilators; Maintain ambient temperature of more than 30°C to prevent heat loss and induce further increases in metabolic rate; Limitations with burns necessitate creativity. ECG needle probes for contact or topical antibiotic cream below ECG electrodes may be necessary. Respiratory: Early - Assess airway early via direct layngocopy, fiberoptic nasopharyngoscopy, bronchoscopy, or flow-volume loops; Succinylcholine permissible in patients with acute burn within first 48 hours; Choose induction agent based on cardiovascular stability and available history. Late - Ventilation and oxygenation challenging; May require portable ventilator to deliver minute volumes of more than 30 L/min; Requires high-flow oxygen and PEEP. Cardiovascular: Burn shock occurs as a result of massive vasodilation; Blood pressure is labile and may require vasopressors; Know status of fluid resuscitation; Avoid displacement of monitors; Beta blockade during the hypermetabolic phase attenuates tachycardia and HTN without adversely affecting protein or lipid metabolism. Hematologic: Blood loss difficult to estimate; Communicate with surgeon concerning area to be excised as an aid in estimating blood loss; Thrombocytopenia may be present. Hepatic: Hepatic injury may occur as a result of hypoxia or hypotension. Drug metabolism may be increased or decreased because of altered protein binding or changes in hepatic blood flow. Renal: Acute renal failure may occur as a result of hypovolemia and decreased renal perfusion. Monitor closely. May require dopamine. CNS: Consider hypermetabolic phase with regard to hypertension, tachycardia, and hyperthermia; avoid overadministration of narcotics in this instance; electrolyte abnormalities not uncommon.
ASJC Scopus subject areas
- Anesthesiology and Pain Medicine