Book contents
- Frontmatter
- Contents
- Foreword
- Foreword
- Preface
- Acknowledgments
- Contributors
- 1 Mechanisms and Demographics in Trauma
- 2 Trauma Airway Management
- 3 Shock Management
- 4 Establishing Vascular Access in the Trauma Patient
- 5 Monitoring the Trauma Patient
- 6 Fluid and Blood Therapy in Trauma
- 7 Massive Transfusion Protocols in Trauma Care
- 8 Blood Loss: Does It Change My Intravenous Anesthetic?
- 9 Pharmacology of Neuromuscular Blocking Agents and Their Reversal in Trauma Patients
- 10 Anesthesia Considerations for Abdominal Trauma
- 11 Head Trauma – Anesthesia Considerations and Management
- 12 Intensive Care Unit Management of Pediatric Brain Injury
- 13 Surgical Considerations for Spinal Cord Trauma
- 14 Anesthesia for Spinal Cord Trauma
- 15 Musculoskeletal Trauma
- 16 Anesthetic Considerations for Orthopedic Trauma
- 17 Cardiac and Great Vessel Trauma
- 18 Anesthesia Considerations for Cardiothoracic Trauma
- 19 Intraoperative One-Lung Ventilation for Trauma Anesthesia
- 20 Burn Injuries (Critical Care in Severe Burn Injury)
- 21 Anesthesia for Burns
- 22 Field Anesthesia and Military Injury
- 23 Eye Trauma and Anesthesia
- 24 Pediatric Trauma and Anesthesia
- 25 Trauma in the Elderly
- 26 Trauma in Pregnancy
- 27 Oral and Maxillofacial Trauma
- 28 Damage Control in Severe Trauma
- 29 Hypothermia in Trauma
- 30 ITACCS Management of Mechanical Ventilation in Critically Injured Patients
- 31 Trauma and Regional Anesthesia
- 32 Ultrasound Procedures in Trauma
- 33 Use of Echocardiography and Ultrasound in Trauma
- 34 Pharmacologic Management of Acute Pain in Trauma
- 35 Posttrauma Chronic Pain
- 36 Trauma Systems, Triage, and Transfer
- 37 Teams, Team Training, and the Role of Simulation in Trauma Training and Management
- Index
- Plate section
- References
21 - Anesthesia for Burns
Published online by Cambridge University Press: 18 January 2010
Book contents
- Frontmatter
- Contents
- Foreword
- Foreword
- Preface
- Acknowledgments
- Contributors
- 1 Mechanisms and Demographics in Trauma
- 2 Trauma Airway Management
- 3 Shock Management
- 4 Establishing Vascular Access in the Trauma Patient
- 5 Monitoring the Trauma Patient
- 6 Fluid and Blood Therapy in Trauma
- 7 Massive Transfusion Protocols in Trauma Care
- 8 Blood Loss: Does It Change My Intravenous Anesthetic?
- 9 Pharmacology of Neuromuscular Blocking Agents and Their Reversal in Trauma Patients
- 10 Anesthesia Considerations for Abdominal Trauma
- 11 Head Trauma – Anesthesia Considerations and Management
- 12 Intensive Care Unit Management of Pediatric Brain Injury
- 13 Surgical Considerations for Spinal Cord Trauma
- 14 Anesthesia for Spinal Cord Trauma
- 15 Musculoskeletal Trauma
- 16 Anesthetic Considerations for Orthopedic Trauma
- 17 Cardiac and Great Vessel Trauma
- 18 Anesthesia Considerations for Cardiothoracic Trauma
- 19 Intraoperative One-Lung Ventilation for Trauma Anesthesia
- 20 Burn Injuries (Critical Care in Severe Burn Injury)
- 21 Anesthesia for Burns
- 22 Field Anesthesia and Military Injury
- 23 Eye Trauma and Anesthesia
- 24 Pediatric Trauma and Anesthesia
- 25 Trauma in the Elderly
- 26 Trauma in Pregnancy
- 27 Oral and Maxillofacial Trauma
- 28 Damage Control in Severe Trauma
- 29 Hypothermia in Trauma
- 30 ITACCS Management of Mechanical Ventilation in Critically Injured Patients
- 31 Trauma and Regional Anesthesia
- 32 Ultrasound Procedures in Trauma
- 33 Use of Echocardiography and Ultrasound in Trauma
- 34 Pharmacologic Management of Acute Pain in Trauma
- 35 Posttrauma Chronic Pain
- 36 Trauma Systems, Triage, and Transfer
- 37 Teams, Team Training, and the Role of Simulation in Trauma Training and Management
- Index
- Plate section
- References
Summary
Objectives
Understand the pathophysiology of a burn patient, including airway, respiratory, cardiac, hematologic, liver, and gastrointestinal functions, nutrition, metabolism, electrolyte abnormalities, thermoregulation, immune suppression, and renal function.
Understand the preoperative requirements for surgery, including a thorough history and physical, proper laboratory tests, appropriate intravenous access, and preoperative medications.
Understand the surgical process of wound care, excision and grafting, and alternative skin care.
To safely administer intraoperative anesthetic management, including proper monitor selection, thermal regulation, ventilation, maintenance anesthesia, and calculation of the estimated blood loss during the excision.
To give appropriate postoperative care, including the management of the airway and chronic pain control.
INTRODUCTION
Burn injury is regarded as one the most costly and challenging of all trauma care [1]. The skin is the largest organ of the human body, and it plays a very important role in physiology and the maintenance of body homeostasis. A large burn can alter the ability of almost all of the body's organs and significantly increase the patient's risk for infection [2]. It is estimated that about 1 million burn injuries are treated per year, with about 50,000 requiring hospitalization, and about 6,000 related deaths [1, 3, 4]. About one third of all burn admissions to the hospital are children under age 15 years, and about 2,000 of the burn-related deaths annually are in children [2]. Mortality is high with burn injuries, but in recent years there has been a significant improvement in survival secondary to the development of multidisciplinary burn teams, early and aggressive surgical treatments, advances in critical care, and improved understanding of burn pathophysiology [3, 4].
- Type
- Chapter
- Information
- Trauma Anesthesia , pp. 322 - 342Publisher: Cambridge University PressPrint publication year: 2008
References
, Perioperative anesthetic management of patients with burns. Anesthesiol Clin N Am 1999;17(1):237–49.CrossRefGoogle Scholar
, , Anesthesia for major thermal injury. Anesthesiology 1998;89(3):749–70.CrossRefGoogle ScholarPubMed
, , Environmental emergencies: thermal injury. Crit Care Clin 1999;15(2):333–52.CrossRefGoogle Scholar
, , , et al. Smoke inhalation injury: Evaluation of radiographic manifestations and pulmonary dysfunction. J Trauma 1989;29(9):1232–8.CrossRefGoogle ScholarPubMed
, , , et al. Fiberoptic bronchoscopy for the early diagnosis of subglottal inhalation injury: Comparative value in the assessment of prognosis. J Trauma 1994;36(1):59–67.CrossRefGoogle ScholarPubMed
, , , et al. Efficacy of fiberoptic laryngoscopy in the diagnosis of inhalation injuries. Arch Otolaryngol Head Neck Surg 1998;124(9):1003–7.CrossRefGoogle Scholar
, , , et al. Acute upper airway injury in burn patients. Serial changes of flow-volume curves and nasopharyngoscopy. Am Rev Respir Dis 1987;135(2):360–6.Google ScholarPubMed
, Respiration in anesthesia pathophysiology and clinical update. Anesthesiol Clin N Am 1998;16(1):29–75.CrossRefGoogle Scholar
, , Clinical Anesthesia, 4th edition. Philadelphia: Lippincott Williams & Wilkins, 2001.Google Scholar
, , Effects of carboxyhemoglobin on the accuracy of mixed venous oximetry monitors in dogs. Crit Care Med 1994;22(7):1181–5.CrossRefGoogle Scholar
, , , et al. Continuous nebulized albuterol attenuates acute lung injury in an ovine model of combined burn and smoke inhalation. Crit Care Med 2006;34(6):1841–2.CrossRefGoogle Scholar
, , , et al. Pneumonia in patients with severe burns: A classification according to the concepts of the carrier state. Chest 2001;119(4):1160–5.CrossRefGoogle Scholar
, , , et al. Cardiac effects of burn injury complicated by aspiration pneumonia-induced sepsis. Am J Physiol 2003;285(1):H47–58.Google ScholarPubMed
, , , et al. Effect of blood transfusion on outcome after major burn injury: A multicenter study. Crit Care Med 2006;34(6):1602–7.CrossRefGoogle ScholarPubMed
Townsend CM, Beauchamp RD, Evers BM, et al. Burns. Chapter 22. Sabiston Textbook of Surgery, 17th edition. Edited by , . Philadelphia: Saunders, 2004,Google Scholar
, , , et al. Relationship between hepatic blood flow and tissue lipid peroxidation in the early postburn period. Crit Care Med 1992;20(6):789–96.CrossRefGoogle ScholarPubMed
, , The role of the gastrointestinal tract in the development of burn sepsis. Plast Reconst Surg 1992;90(3):524–31.CrossRefGoogle ScholarPubMed
What's new in general surgery: Burns and metabolism. J Am Coll Surg 2003;196(2):267–89.CrossRefGoogle ScholarPubMed
, , , et al. Assessment of splanchnic perfusion by gastric tonometry in patients with acute hypovolemic burn shock. Burns 2006;32:689–94.CrossRefGoogle ScholarPubMed
, . Burns, bacterial translocation, gut barrier function, and failure. J Burn Care Rehabil 2005;26(5):383–91.CrossRefGoogle ScholarPubMed
, Metabolic management in patients with severe burns. World J Surg 2000;24(6):673–80.CrossRefGoogle ScholarPubMed
, , , et al. Neuroleptic malignant syndrome in the burns patient?Burns 2006;32:647–49.CrossRefGoogle ScholarPubMed
, , Treatment of white phosphorus and other chemical burn injuries at one burn center over a fifty-one year period. Burns 2004;30(5):448–52.CrossRefGoogle Scholar
, , , et al. Methamphetamine laboratory explosions: A new and emerging burn injury. J Burn Care Rehabil 2005;26(3):228–32.Google ScholarPubMed
, , , et al. Characteristic of burn patients injured in methamphetamine laboratory explosions. J Burn Care Res 2006;27(4):496–501.CrossRefGoogle Scholar
, , , et al. Patterns of grease burn injury: Development of a classification system. Burns 2005;31(6):765–7.CrossRefGoogle ScholarPubMed
, , An evaluation of risk factors for mortality after burn trauma and the identification of gender-dependent differences and outcomes. J Am College Surg 2001;192(2):153–60.CrossRefGoogle Scholar
, , , et al. Young age is not a predictor of mortality in burns. Pediatric Crit Care Med 2001;2(3):223–4.CrossRefGoogle Scholar
, , , et al. Factors affecting mortality and epidemiological data in patients hospitalised with burns in Diyarbakir, Turkey. S Afr J Surg 2005;43(4):159–62.Google ScholarPubMed
, , , et al. Sex differences in mortality after burn injury: Results of analysis of the national burn repository of the American Burn Association. J Burn Care Res 2006;27(4):452–6.CrossRefGoogle ScholarPubMed
, , , et al. Mortality determinants in massive pediatric burns. An analysis of 103 children with >=80% TBSA burns (>=70% full-thickness). Ann Surg 1997;225(5):554–69.CrossRefGoogle Scholar
, , Infections in diabetic burn patients. Diabetes Care 2004;27(1):229–33.CrossRefGoogle ScholarPubMed
, , , et al. Unfavorable outcome of burn patients with neuropsychiatric disorders. Tohoku J Exp Med 2005;205(3):241–5.CrossRefGoogle ScholarPubMed
, , , et al. The impact of combined trauma and burns on patient mortality. J Trauma 2005;58(2):284–8.CrossRefGoogle ScholarPubMed
, , Ordering of laboratory work in the management of pediatric burn patients: Technical note. J Trauma 1993;34(1):139–41.CrossRefGoogle ScholarPubMed
, . Ultrasound guidance for vascular access. Emerg Med Clin N Am 2004;22(3):749–73.CrossRefGoogle ScholarPubMed
, , , et al. Intraosseous infusion – a technique available for intravascular administration of drugs and fluids in the child with burns. Burns 1995;21(7):552–3.CrossRefGoogle Scholar
, , , et al. Effects of delayed wound excision and grafting in severely burned children. Arch Surg. 2002;137(9):1049–54.CrossRefGoogle ScholarPubMed
, , , et al. A clinical randomized study on the effects of invasive monitoring on burn shock resuscitation. Burns 2004;30:798–807.CrossRefGoogle ScholarPubMed
, , , et al. Evaluation of oesophageal reflectance pulse oximetry in major burn patients. Burns 2005;31:337–41.CrossRefGoogle Scholar
, , , et al. Transcardiopulmonary vs. pulmonary arterial thermodilution methods for hemodynamic monitoring of burned patients. J Burn Care Rehabil 2002;23:21–6.CrossRefGoogle ScholarPubMed
, , , et al. Arterial thermodilution: An alternative to pulmonary artery catheter for cardiac output assessment in burn patients. Burns 2000;27:161–6.CrossRefGoogle Scholar
, , A comparison of the effect of early insertion of standard latex and silver-impregnated latex foley catheters on urinary tract infections in burn patients. Infect Control Hosp Epidemiol 2002;23(4):217–8.CrossRefGoogle ScholarPubMed
, Infusion of hot crystalloid during operative burn wound debridement. J Trauma 1997;42(6):1112–5.CrossRefGoogle ScholarPubMed
, Pathophysiology and management of perioperative hypothermia. Pol Merkuriusc Lek 2006;20(120):629–34.Google ScholarPubMed
, , Use of high-frequency oscillatory ventilation in burn patients. Crit Care Med 2005;33(3):175–81.CrossRefGoogle ScholarPubMed
, , , et al. Is high PEEP low volume ventilation in burn patients beneficial? A retrospective study in 61 patients. Burns 2004;30:368–73.CrossRefGoogle ScholarPubMed
. Pathophysiology and pharmacokinetics following burn injury. Clin Pharmacokinet 1990;18(2):118–30.CrossRefGoogle ScholarPubMed
, , , et al. Determinants of blood loss during primary burn excision. Surgery 2001;130:396–402.CrossRefGoogle ScholarPubMed
, , , et al. Results of a protocol of transfusion threshold and surgical technique on transfusion requirements in burn patients. Burns 2005;31:558–61.CrossRefGoogle ScholarPubMed
, , , et al. Reduced blood loss during burn surgery. J Burn Care Rehabil 2001;22:111–7.CrossRefGoogle ScholarPubMed
, , , et al. Haemostatic disturbances in burned patients during early excision and skin grafting. Blood Coagul Fibrinolysis 1998;9(1):19–28.CrossRefGoogle ScholarPubMed
, , , et al. A prospective study on the implications of a base deficit during fluid resuscitation. J Burn Care Rehabil 2003;24:75–84.CrossRefGoogle ScholarPubMed
, , , et al. Lactate: Early predictor of morbidity and mortality in patients with severe burns. Burns 2005;31:986–90.CrossRefGoogle ScholarPubMed
, , , et al. A perspective study of the safety of tracheal extubation using a pediatric airway exchange catheter for patients with a known difficult airway. Chest 1997;111(6):1660–5.Google Scholar
, , Early tracheostomy does not improve outcome in burn patients. J Burn Care Rehabil 2002;23(6):431–8.CrossRefGoogle Scholar
, , , et al. Percutaneous versus conventional tracheostomy in burned patients with inhalational injury. World J Surg 2005;29(12):1571–5.CrossRefGoogle Scholar
, , Benefits of early tracheostomy in severely burned children. Crit Care Med 2002;30(4):922–4.CrossRefGoogle ScholarPubMed
, , Rosen's Emergency Medicine: Concepts and Clinical Practices, 6th edition. St Louis: Mosby, 2006.Google Scholar
, , , et al. A comparison of oral transmucosal fentanyl citrate and oral hydromorphone for inpatient pediatric burn wound care analgesia. J Burn Care Rehabil 1998;19(6):516–21.CrossRefGoogle Scholar
, , , et al. Ketamine improves survival in burn injury followed by sepsis in rats. Anesth Analg 2006;103(2):396–402.CrossRefGoogle ScholarPubMed
, , , et al. Sedation using dexmedetomidine in pediatric burn patients. J Burn Care Res 2006;27(2):206–10.CrossRefGoogle ScholarPubMed
, , , et al. Quality-of-life and outcome predictors following massive burn injury. Plast Reconstr Surg 2005;116(3):791–7.CrossRefGoogle ScholarPubMed