Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-669899f699-cf6xr Total loading time: 0 Render date: 2025-04-28T21:36:25.885Z Has data issue: false hasContentIssue false

21 - Anesthesia for Burns

Published online by Cambridge University Press:  18 January 2010

By
Jessica Anne Lovich-Sapola
Edited by
Charles E. Smith
Jessica Anne Lovich-Sapola
Affiliation:
Department of Anesthesiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
Charles E. Smith
Affiliation:
Case Western Reserve University, Ohio
Get access

Summary

Objectives

  1. 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.

  2. Understand the preoperative requirements for surgery, including a thorough history and physical, proper laboratory tests, appropriate intravenous access, and preoperative medications.

  3. Understand the surgical process of wound care, excision and grafting, and alternative skin care.

  4. 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.

  5. 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 - 342
Publisher: Cambridge University Press
Print publication year: 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Book purchase

Temporarily unavailable

References

Blanding, R, Stiff, J.Perioperative anesthetic management of patients with burns. Anesthesiol Clin N Am 1999;17(1):237–49.CrossRefGoogle Scholar
Purdue, GF, Hunt, JL, Burris, AM.Pediatric surgical emergencies. Clin Pediatr Emerg Med 2002;3(1):76–82.CrossRefGoogle Scholar
MacLennan, N, Heimbach, DM, Cullen, BF.Anesthesia for major thermal injury. Anesthesiology 1998;89(3):749–70.CrossRefGoogle ScholarPubMed
Ramzy, PI, Barret, JP, Herndon, DN.Environmental emergencies: thermal injury. Crit Care Clin 1999;15(2):333–52.CrossRefGoogle Scholar
Peitzman, AB, Shires, GT, Teixidor, HS, et al. Smoke inhalation injury: Evaluation of radiographic manifestations and pulmonary dysfunction. J Trauma 1989;29(9):1232–8.CrossRefGoogle ScholarPubMed
Masanes, MJ, Legendre, C, Lioret, N, 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
Muehlberger, T, Kunar, D, Munster, A, et al. Efficacy of fiberoptic laryngoscopy in the diagnosis of inhalation injuries. Arch Otolaryngol Head Neck Surg 1998;124(9):1003–7.CrossRefGoogle Scholar
Haponik, EF, Meyers, DA, Munster, AM, 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
Wilson, WC, Benumof, JL.Respiration in anesthesia pathophysiology and clinical update. Anesthesiol Clin N Am 1998;16(1):29–75.CrossRefGoogle Scholar
Barash, PG, Cullen, BF, Stoelting, RK.Clinical Anesthesia, 4th edition. Philadelphia: Lippincott Williams & Wilkins, 2001.Google Scholar
Haney, M, Tait, AR, Tremper, KK.Effects of carboxyhemoglobin on the accuracy of mixed venous oximetry monitors in dogs. Crit Care Med 1994;22(7):1181–5.CrossRefGoogle Scholar
Palmieri, TL, Enkhbaatar, P, Bayliss, R, 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
Cal, MA, Cerda, E, Garcia-Hierro, P, 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
White, J, Thomas, J, Maass, DL, et al. Cardiac effects of burn injury complicated by aspiration pneumonia-induced sepsis. Am J Physiol 2003;285(1):H47–58.Google ScholarPubMed
Palmieri, TL, Caruso, DM, Foster, KN, 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 Wolf, SE, Herndon, DN. Philadelphia: Saunders, 2004,Google Scholar
Lalonde, C, Knox, J, Youn, YK, 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
Epstein, MD, Banducci, DR, Manders, EK.The role of the gastrointestinal tract in the development of burn sepsis. Plast Reconst Surg 1992;90(3):524–31.CrossRefGoogle ScholarPubMed
Saffle, JR.What's new in general surgery: Burns and metabolism. J Am Coll Surg 2003;196(2):267–89.CrossRefGoogle ScholarPubMed
Holm, C, Horbrand, F, Mayr, M, et al. Assessment of splanchnic perfusion by gastric tonometry in patients with acute hypovolemic burn shock. Burns 2006;32:689–94.CrossRefGoogle ScholarPubMed
Magnotti, LJ, Deitch, EA. Burns, bacterial translocation, gut barrier function, and failure. J Burn Care Rehabil 2005;26(5):383–91.CrossRefGoogle ScholarPubMed
Demling, RH, Seigne, P.Metabolic management in patients with severe burns. World J Surg 2000;24(6):673–80.CrossRefGoogle ScholarPubMed
Pereira, CT, Murphy, KD, Herndon, DN. Altering metabolism. J Burn Care Rehabil 2005;26(3):194–9.Google ScholarPubMed
Goh, KP.Management of hyponatremia. Am Fam Physician 2004;69(10):2387–94.Google ScholarPubMed
Cawrse, N, Wilson, S, Williams, M, et al. Neuroleptic malignant syndrome in the burns patient?Burns 2006;32:647–49.CrossRefGoogle ScholarPubMed
Koumbourlis, AC. Electrical injuries. Crit Care Med 2002;30(11):S424–30.CrossRefGoogle ScholarPubMed
Barillo, DJ, Cancio, LC, Goodwin, CW.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
Santos, AP, Wilson, AK, Hornung, CA, et al. Methamphetamine laboratory explosions: A new and emerging burn injury. J Burn Care Rehabil 2005;26(3):228–32.Google ScholarPubMed
Spann, MD, McGwin, G, Kerby, JD, et al. Characteristic of burn patients injured in methamphetamine laboratory explosions. J Burn Care Res 2006;27(4):496–501.CrossRefGoogle Scholar
Klein, MB, Gibran, NS, Emerson, D, et al. Patterns of grease burn injury: Development of a classification system. Burns 2005;31(6):765–7.CrossRefGoogle ScholarPubMed
O'Keefe, GE, Hunt, JL, Purdue, GF.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
Sheridan, RL, Weber, JM, Schnitzer, JJ, et al. Young age is not a predictor of mortality in burns. Pediatric Crit Care Med 2001;2(3):223–4.CrossRefGoogle Scholar
Aldemir, M, Kara, IH, Girgin, S, 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
Kerby, JD, McGwin, G, George, RL, 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
Wolf, SE, Rose, JK, Desai, MH, 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
Maghsoudi, H, Samnia, R, Garadaghi, A, et al. Burns in pregnancy. Burns 2006;32(2):246–50.CrossRefGoogle ScholarPubMed
Memmel, H, Kowal-Vern, A, Latenser, BA.Infections in diabetic burn patients. Diabetes Care 2004;27(1):229–33.CrossRefGoogle ScholarPubMed
Yanagawa, Y, Saitoh, D, Sakamoto, T, et al. Unfavorable outcome of burn patients with neuropsychiatric disorders. Tohoku J Exp Med 2005;205(3):241–5.CrossRefGoogle ScholarPubMed
Hawkins, A, MacLennan, PA, McGwin, G, et al. The impact of combined trauma and burns on patient mortality. J Trauma 2005;58(2):284–8.CrossRefGoogle ScholarPubMed
Housinger, TA, Warden, GD, Shouse, J.Ordering of laboratory work in the management of pediatric burn patients: Technical note. J Trauma 1993;34(1):139–41.CrossRefGoogle ScholarPubMed
Abboud, PC, Kendall, JL. Ultrasound guidance for vascular access. Emerg Med Clin N Am 2004;22(3):749–73.CrossRefGoogle ScholarPubMed
Evans, RJ, Jewkes, F, Owen, G, 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
Ong, YS, Samuel, M, Song, C.Meta-analysis of early excision of burns. Burns 2006;32(2):145–50.CrossRefGoogle ScholarPubMed
Xiao-Wu, W, Herndon, DN, Spies, M, et al. Effects of delayed wound excision and grafting in severely burned children. Arch Surg. 2002;137(9):1049–54.CrossRefGoogle ScholarPubMed
Holm, C, Mayr, M, Tegeler, J, et al. A clinical randomized study on the effects of invasive monitoring on burn shock resuscitation. Burns 2004;30:798–807.CrossRefGoogle ScholarPubMed
Pal, SK, Kyriachou, PA, Kumaran, S, et al. Evaluation of oesophageal reflectance pulse oximetry in major burn patients. Burns 2005;31:337–41.CrossRefGoogle Scholar
Miller, RD.Anesthesia, 6th edition. New York: Churchill Livingstone, 2005.Google ScholarPubMed
Kuntscher, MV, Blome-Eberwein, S, Pelzer, M, et al. Transcardiopulmonary vs. pulmonary arterial thermodilution methods for hemodynamic monitoring of burned patients. J Burn Care Rehabil 2002;23:21–6.CrossRefGoogle ScholarPubMed
Holm, C, Melcer, B, Horbrand, F, et al. Arterial thermodilution: An alternative to pulmonary artery catheter for cardiac output assessment in burn patients. Burns 2000;27:161–6.CrossRefGoogle Scholar
Newton, T, Still, JM, Law, E.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
Gore, DC, Beaston, J.Infusion of hot crystalloid during operative burn wound debridement. J Trauma 1997;42(6):1112–5.CrossRefGoogle ScholarPubMed
Sheridan, RL, Szyfelbein, SK.Trends in blood conservation in burn care. Burns 2001;27:272–6.CrossRefGoogle ScholarPubMed
Witkowski, W, Maj, J.Pathophysiology and management of perioperative hypothermia. Pol Merkuriusc Lek 2006;20(120):629–34.Google ScholarPubMed
Cartotto, R, Ellis, S, Smith, T.Use of high-frequency oscillatory ventilation in burn patients. Crit Care Med 2005;33(3):175–81.CrossRefGoogle ScholarPubMed
Wolter, TP, Fuchs, PC, Horvat, N, 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
Bonate, PL. Pathophysiology and pharmacokinetics following burn injury. Clin Pharmacokinet 1990;18(2):118–30.CrossRefGoogle ScholarPubMed
Hart, DW, Wolf, SE, Beauford, RB, et al. Determinants of blood loss during primary burn excision. Surgery 2001;130:396–402.CrossRefGoogle ScholarPubMed
O'Mara, MS, Hayetian, F, Slater, H, 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
Gomez, M, Logsetty, S, Fish, JS, et al. Reduced blood loss during burn surgery. J Burn Care Rehabil 2001;22:111–7.CrossRefGoogle ScholarPubMed
Niemi, T, Svartling, N, Syrjala, M, et al. Haemostatic disturbances in burned patients during early excision and skin grafting. Blood Coagul Fibrinolysis 1998;9(1):19–28.CrossRefGoogle ScholarPubMed
Cartotto, R, Choi, J, Gomez, M, 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
Kamolz, LP, Andel, H, Schramm, W, et al. Lactate: Early predictor of morbidity and mortality in patients with severe burns. Burns 2005;31:986–90.CrossRefGoogle ScholarPubMed
Loudermilk, EP, Hartmannsgruber, M, Stoltzfus, DP, 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
Saffle, JR, Morris, SE, Edelman, L.Early tracheostomy does not improve outcome in burn patients. J Burn Care Rehabil 2002;23(6):431–8.CrossRefGoogle Scholar
Pelosi, P, Svergnini, P.Tracheostomy must be individualized. Crit Care 2004;8(5):322–4.CrossRefGoogle ScholarPubMed
Gravvanis, AI, Tsoussos, DA, Iconomou, TG, et al. Percutaneous versus conventional tracheostomy in burned patients with inhalational injury. World J Surg 2005;29(12):1571–5.CrossRefGoogle Scholar
Palmieri, TL, Jackson, W, Greenhalgh, DG.Benefits of early tracheostomy in severely burned children. Crit Care Med 2002;30(4):922–4.CrossRefGoogle ScholarPubMed
Marx, J, Hockberger, R, Walls, R.Rosen's Emergency Medicine: Concepts and Clinical Practices, 6th edition. St Louis: Mosby, 2006.Google Scholar
Sharar, SR, Bratton, SL, Carrougher, GJ, 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
Gurfinkel, R, Czeiger, D, Douvdevani, A, et al. Ketamine improves survival in burn injury followed by sepsis in rats. Anesth Analg 2006;103(2):396–402.CrossRefGoogle ScholarPubMed
Walker, J, Maccallum, M, Fischer, C, et al. Sedation using dexmedetomidine in pediatric burn patients. J Burn Care Res 2006;27(2):206–10.CrossRefGoogle ScholarPubMed
Anzarut, A, Chen, M, Shankowsky, H, et al. Quality-of-life and outcome predictors following massive burn injury. Plast Reconstr Surg 2005;116(3):791–7.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

  • Anesthesia for Burns
    • By Jessica Anne Lovich-Sapola, Department of Anesthesiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
  • Edited by Charles E. Smith, Case Western Reserve University, Ohio
  • Book: Trauma Anesthesia
  • Online publication: 18 January 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547447.024
Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

  • Anesthesia for Burns
    • By Jessica Anne Lovich-Sapola, Department of Anesthesiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
  • Edited by Charles E. Smith, Case Western Reserve University, Ohio
  • Book: Trauma Anesthesia
  • Online publication: 18 January 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547447.024
Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Anesthesia for Burns
    • By Jessica Anne Lovich-Sapola, Department of Anesthesiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
  • Edited by Charles E. Smith, Case Western Reserve University, Ohio
  • Book: Trauma Anesthesia
  • Online publication: 18 January 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547447.024
Available formats
×