Anesthesia for Burn Patients
There have been a lot of strides in burn care in recent decades so that most people survive even severe burns. Attention has now been moved away from survival to making burn patients more comfortable as they heal from a major trauma. Read on to learn more.Burn Patients and Anesthesia | How We Can HelpIn this article:
- Why Do Burn Patients Need Anesthesia?
- What Medical Teams Look Out For When Deciding Anesthesia For Burn Patients
- Evaluation Before Surgery
- Yes, Size Matters
- Clearing The Airways
- Back From The Dead?
- Constant Adjustments
- In the Operating Room
- Constant Vigilance
- Which "Sleeper Agents" To Use
- Blood Transfusions And Burn Patients
Anesthesia is the art of keeping the patient comfortable during the often several surgeries and multiple dressing changes that need to take place as part of the healing process.
The treatment of burn patients requires a multidisciplinary team of surgeons, nutritionists, internists, respiratory therapy providers, nurses, rehabilitation providers, and anesthesiologists. The anesthesiologists and anesthetists become the experts in gaining vascular access, airway management, lung care and support of the body through fluid and electrolyte management along with their primary expertise in alleviating pain and altering consciousness during surgery.What Medical Teams Look Out For When Deciding Anesthesia For Burn PatientsThere are a number of challenges the anesthesia team faces when dealing with a burn patient around surgery. Some of these include:
- Lung problems/insufficiency
- Airway compromise
- Other injuries
- Changed mental status
- Rapid blood loss
- Limited IV access
- Low hemoglobin
- Heart arrhythmias
- Poor temperature regulation
- Kidney problems
- Poor immune system
- Infection or sepsis
Anesthesiologists must look at the following things before bringing the patient to the operating room for surgery. They need to look at the age of the patient as older people tend to need special care during surgery. They need to know the extent of the burn so as to gauge the amount of fluid the patient will need in surgery. The need to know the type of burn and whether or not there has been a lung or inhalation injury.Yes, Size MattersThe size of the burn matters when it comes to anesthesia. Large burns set up an inflammatory response that affects the function of all the body organs, including the liver and kidneys. If the burns are deep, there will be more blood loss in surgery, as well as more fluid loss. Blood products might be immediately necessary to make up for the loss incurred during debridement surgery.Clearing The Airways
The airway must be clear and be able to pass an endotracheal tube during surgery. The lungs may be damaged due to smoke inhalation, and the anesthesiologist needs to be prepared for these burn injuries. Sometimes, using an endotracheal tube unnecessarily because of suspected lung damage is dangerous because it can further inflame upper airway tissues. The anesthesiologist must weigh these factors in the management of the perioperative patient.
The burn can severely affect circulation. Shock can develop from poor cardiac output and increased resistance of the blood flow in the arteries. The tissues don’t get enough circulation. Fluid shifts from the bloodstream to the lymph tissue and body tissues. Severe burns can suppress the function of the heart, further contributing to shock development. The patient may need large volumes of fluid by IV in order to make up for fluid shifts and fluid loss.
Back From The Dead?Resuscitation by the anesthetist begins with giving enough fluids and ends with making sure the patient is getting enough oxygen. Usually, giving fluids like IV Lactated Ringer’s solution are all that is necessary, but some patients will need blood products or protein-containing fluid as well. More fluid is needed if the patient has the following situations:
- Delayed resuscitation
- Lung injury
- Crushing injury
- Other injuries/trauma
- Large full-thickness burns
Blood transfusions may need to be given during surgery. Most experts believe that there should be blood transfusions if the hemoglobin has dropped to the 6-10 g/dl range. Patients with heart or lung problems need more blood transfusions at a higher hemoglobin concentration than normal patients. Ideally, blood should be given as the blood is being lost during surgery and not after the patient’s blood pressure and blood volume have already been diminished.
There are complications to giving too much blood. The blood can become too thin from a lack of platelets in the transfused blood, so that excess bleeding occurs. Citrate used to preserve blood can reach toxic levels. Potassium shifts can occur, which can cause heart arrhythmias. The patient can become too cold if large amounts of cold blood products are given. The lungs can also fill with fluid if large amounts of blood are necessary. Blood transfusions also increase the risk of wound infection.
This video from IMET2000-PAL discusses the different types of anesthetics for burn patients:
In summary, anesthetic management of burn patients is complex and tricky. Many things factor into the way the patient is managed and how much fluid, oxygen, blood, and medications are given. An anesthesiologist caring for burn patients must understand the complexities of burns and burn care in order to maintain the person’s vital signs before, during and after surgery.
A serious burn is a catastrophe. Anyone who has a serious burn through the negligence of another should contact an experienced catastrophic injury lawyer.
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Editor's Note: This article has been updated for quality and relevancy.