Anesthesia for burned patients

Woodson, Lee C.; Sherwood, Edward R.; Aarsland, Asle; Talon, Mark; Kinsky, Michael P.; Morvant, Elise M.

doi:10.1016/b978-1-4377-2786-9.00014-x

Cited by 8 publications

(8 citation statements)

References 205 publications

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“…In particular, patients with burns over 25% of their total body surface area are likely to have facial burns as well as inhalation injury due to smoke or flame from the fire, resulting in difficult intubation. Even patients without burns on the face and the neck may receive large amounts of fluids in the early stages of burn treatment; this can cause secondary generalized and oral cavity/airway edema which also adds to a more difficult airway management [2]. …”

Section: Introductionmentioning

confidence: 99%

“…Excessive hemodynamic changes can be fatal in severe burn patients with a hypermetabolic state characterized by changes in blood flow, capillary permeability, protein synthesis and cardiac output in addition to accompanying tachycardia [2]. Therefore, it is necessary to examine the hemodynamic differences during endotracheal intubation when using AWS compared to Macintosh laryngoscope in severe burn patients.…”

Section: Introductionmentioning

confidence: 99%

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Macintosh laryngoscope vs. Pentax-AWS video laryngoscope: comparison of efficacy and cardiovascular responses to tracheal intubation in major burn patients

Woo

Kim

Park

et al. 2012

Korean J Anesthesiol

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BackgroundPatients with major burns accompanied with airway edema need more attention for airway management. Although the Pentax-AWS has an advantage in managing endotracheal intubation more easily, its usefulness cannot be assured if it does not maintain hemodynamic stability in burn patients. The aim of this study was to compare cardiovascular responses and general efficacy of the Pentax-AWS and Macintosh laryngoscopes in burn patients.MethodsAmerican Society of Anesthesiologists physical status 2 or 3 adult patients with major burn injury were randomly assigned to group P (AWS, n = 50) or group M (Macintosh, n = 50). Fifty-nine patients assigned to the Macintosh group and no patient to AWS group were excluded because of failure to first intubation. Hemodynamic data at baseline, just before and after intubation as well as 3, 5 and 10 minutes after intubation and grade of sore throat were recorded in two groups. Intubation time, success rate of intubation, number of intubation attempts and the percentage of glottic opening (POGO) scores were also observed and analyzed in all patients.ResultsA statistically significant increase in heart rate just after laryngoscopy was seen in group M. The success rate of the first attempt in group P (100%) was greater than with the group M (46%). POGO scores were higher in group P (97 ± 4%) than in group M (48 ± 29%)ConclusionsThe use of Pentax-AWS offers a reduced degree of heart rate elevation compared with the Macintosh laryngoscope and better intubation environments in major burn patients.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Macintosh laryngoscope vs. Pentax-AWS video laryngoscope: comparison of efficacy and cardiovascular responses to tracheal intubation in major burn patients

Woo

Kim

Park

et al. 2012

Korean J Anesthesiol

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“…The great quantity of fluid that must be administered for the purpose of resuscitation usually worsens the increased capillary permeability and interstitial edema. Burns make body fluid loss in the area of the wound inevitable [11]. At this point the intravascular volume relatively decreases, which may cause the patient to have a reaction to the drugs that change intravascular resistance.…”

Section: Discussionmentioning

confidence: 99%

The BIS and hemodynamic changes in major burn patients according to a slow infusion of propofol for induction

Bae

Choi

Woo

et al. 2011

Korean J Anesthesiol

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BackgroundMany pathophysiologic alterations in patients with major burns can cause changes in the response of propofol. The aim of this study is to determine the appropriate induction dose of propofol using a slow infusion rate for major burn patients to obtain desirable sedation and hypnotic conditions with minimal hemodynamic changes.Methods45 adults with major burns and who were electively scheduled for escharectomy less than a week after injury were recruited. For induction with propofol, the patients were randomly allocated to one of two groups (group 1: 1.5 mg/kg, n = 20 and group 2: 2.0 mg/kg, n = 25). The infusion rate was 20 mg/kg/hr. The systolic and diastolic blood pressure (SBP, DBP), the heart rate, the bispectral index and the modified observers' assessment of the alertness/sedation scale (OAA/S) were measured before the induction and after the propofol infusion, as well as immediately, 3 and 5 minutes after intubation.ResultsThe SBP and DBP were significantly decreased after the propofol infusion in both group, but there were no significant differences between the two groups. The BIS values after the propofol infusion and intubation were 44.2 ± 16.1 and 43.5 ± 13.8 in group 1, and 45.6 ± 10.3 and 46.5 ± 11.4 in group 2, respectively, and there were no differences between the 2 groups.ConclusionsWhen propofol is administrated to major burn patients, an induction dose of 1.5 mg/kg is appropriate and a slow infusion rate of 20 mg/kg/hr is safe for maintaining the desired hypnotic conditions and this dose and rate cause no significant hemodynamic problems.

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“…Hypothermia in these patients is poorly tolerated as it causes an exaggerated increase in oxygen consumption and exacerbates the catabolic response to the injuries. 86 Decreased body temperature during burn excisions may also increase blood loss and worsen morbidity and mortality. 87 Multiple strategies are used to maintain body temperature in the operating room, including use of warming blankets, radiant warmers, blood/fluid warmers, minimizing skin surface exposure, and wrapping the head and extremities with plastic or thermal insulation.…”

Section: Intraoperative Managementmentioning

confidence: 99%

Acute and Perioperative Care of the Burn-injured Patient

et al. 2015

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Care of burn-injured patients requires knowledge of the pathophysiologic changes affecting virtually all organs from the onset of injury until wounds are healed. Massive airway and/or lung edema can occur rapidly and unpredictably after burn and/or inhalation injury. Hemodynamics in the early phase of severe burn injury are characterized by a reduction in cardiac output, increased systemic and pulmonary vascular resistance. Approximately 2–5 days after major burn injury, a hyperdynamic and hypermetabolic state develops. Electrical burns result in morbidity much higher than expected based on burn size alone. Formulae for fluid resuscitation should serve only as guideline; fluids should be titrated to physiologic end points. Burn injury is associated basal and procedural pain requiring higher than normal opioid and sedative doses. Operating room concerns for the burn-injured patient include airway abnormalities, impaired lung function, vascular access, deceptively large and rapid blood loss, hypothermia and altered pharmacology.

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Anesthesia for burned patients

Cited by 8 publications

References 205 publications

Macintosh laryngoscope vs. Pentax-AWS video laryngoscope: comparison of efficacy and cardiovascular responses to tracheal intubation in major burn patients

Macintosh laryngoscope vs. Pentax-AWS video laryngoscope: comparison of efficacy and cardiovascular responses to tracheal intubation in major burn patients

The BIS and hemodynamic changes in major burn patients according to a slow infusion of propofol for induction

Acute and Perioperative Care of the Burn-injured Patient

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