Total intravenous anaesthesia with tumescent infiltration anaesthesia without definitive airway for early excision and skin grafting in a major burn - A prospective observational study

Abstract

Background and Aims: Patients with major burns posted for early tangential excision and skin grafting pose peculiar challenges for anaesthesiologists. The purpose of the study was to assess safety and efficacy of total intravenous anaesthesia (TIVA) with tumescent infiltration anaesthesia (TIA) for these burn procedures. Methods: This observational single-arm study was conducted on 48 cases of a tertiary centre burn unit, requiring early tangential excision and skin grafting between third and fifth days of burn injury. TIVA was administered using a combination of intravenous (iv) infusion of injection dexmedetomidine and iv boluses of fentanyl, ketamine, propofol, midazolam and paracetamol. TIA was administered in burn wounds after aseptic preparation. Spontaneous breathing was maintained with oxygen supplementation. Haemodynamic and respiratory monitoring was done intraoperatively every 15 minutes and for 6 hours postoperatively. Modified Aldrete's score was calculated at 10 minutes after completion of surgery. Statistical analysis was done using statistical package for the social science software (version 16). Descriptive statistics were used for quantitative variables. Results: Baseline mean HR was 106.95 ± 11.17 bpm (beats per minute). HR settled at 73.17 ± 6.97 bpm during the intraoperative period. The baseline mean arterial pressure (MAP) of 82.42 ± 10.04 mmHg was maintained at 81 ± 7.32 mmHg during the intraoperative period. In all, 95.8% achieved early recovery with mean modified Aldrete's score of ≥9 at 10 minutes post-surgery. There was no episode of apnoea or desaturation. Conclusion: TIVA in combination with TIA minimally interferes with homeostasis and promotes early recovery in patients undergoing early excision and grafting in major burns.

Comparing anesthesia modes in major burns: Total intravenous anesthesia versus general anesthesia - A cross-sectional study in a Central Indian government hospital

“…Salgaonkar et al, in their study, had administered TIVA with tumescent infiltration anesthesia (TIA) and found that 95.8% of the patients had achieved an Aldrete score of 9 or more at 10 min post-surgery. 5 The prevalence of moderate and severe pain was significantly higher in Group G compared to Group T, whereas the prevalence of mild pain was significantly higher in Group T compared to Group G. Pain management was better in Group T patients compared to Group G patients.…”

“…4 The primary goal of management is to stabilize the patient and provide biological cover for the wounds. 5 Kisslagglu et al, revealed that early excision and skin grafting procedures resulted in reduced hospitalization duration and lower costs of burn treatment compared to conservative management. 6 These procedures aim to minimize the risk of infection and scarring while improving cosmetic outcomes.…”

“…[12][13][14] Total intravenous anesthesia (TIVA) without definitive airway management eliminates the need for endotracheal intubation, which may suppress the host immune response. 5 Studies have suggested that propofol, an intravenous anesthetic, can result in less early post-operative pain compared to anesthesia based on isoflurane. 15 The choice of anesthesia approach can significantly impact the release of cytokines, which is crucial for patients with severe burns.…”

Complication Differences Between the Tumescent and Non-Tumescent Dissection Techniques for Mastectomy: A Meta-Analysis

“…The epinephrine in the mixture causes vasoconstriction, which is further enhanced by the tamponading effect of the high volume infiltration on the subdermal vessels (7). Another potential advantage is the analgesic effect offered by the local anesthetic which has been confirmed by researchers (8,9).…”

The Effect of Inhalation Aromatherapy on Sedation Level, Analgesic Dosage, and Bispectral Index Values during Donor Site Dressing in Patients with Burns: A Randomized Clinical Trial

“…[10][11][12] Numerous studies have been conducted on the effect of analgesic and sedative agents such as ketamine, fentanyl, propofol, and midazolam for pain reduction during dressing change in patients with burns. 13,14 Despite the administration of high dosages of analgesics, patients still experience intense pain during these treatments. 15 In addition, the harmful complications of these medications in high doses can aggravate patients' condition.…”