Acute and Perioperative Care of the Burn-injured Patient

• Published in: Anesthesiology (Philadelphia) Vol. 122; no. 2; pp. 448 - 464
• Main Authors: Bittner, Edward A, Shank, Erik, Woodson, Lee, Martyn, J. A Jeevendra
• Format: Journal Article
• Language: English
• Published: United States American Society of Anesthesiologists, Inc 01-02-2015
• Subjects: Anesthesia; Burns - therapy; Burns, Electric - therapy; Burns, Inhalation - therapy; Humans; Pain Management - methods; Perioperative Care - methods
• ISSN: 0003-3022; 1528-1175
• DOI: 10.1097/ALN.0000000000000559

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 is characterized by a reduction in cardiac output and increased systemic and pulmonary vascular resistance. Approximately 2 to 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 endpoints. 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.