Anesthetic management of the burn patient

Edgar J. Pierre, Albert J. Varon

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

The management of thermally injured patients is challenging. Effective treatment is mandatory at the scene of the accident, in the resuscitation bay, the operating room (OR), and the intensive care unit (ICU). Anesthesiologists trained in resuscitation, intraoperative management, and postoperative support are essential members of the burn patient management care team. As our surgical colleagues concentrate on surgical diagnosis and therapy, the anesthesiologist must also provide anesthesia and preserve vital organ functions. Severe burn injuries, defined as burns exceeding 40% of total body surface area (TBSA), occur in approximately 35,000 patients annually. In 15 to 30% of fire victims, smoke inhalation and carbon monoxide intoxication complicate the burn injury. Risk factors associated with mortality include: • Age greater than 60 years • More than 40% of body surface area (BSA) burned • Presence of inhalation injury Mortality can be predicted as 0.3%, 3%, 33%, or approximately 90%, depending on whether zero, one, two, or three of these risk factors are present, respectively. Pathophysiology A thorough knowledge of the pathophysiologic changes that accompany burn injuries facilitates anesthetic management during the three phases of burn injury: 1. Early resuscitation 2. Debridement and grafting 3. Reconstructive phases The pathophysiology of thermal injury is related to the initial distribution of heat within the skin. Most burns involve only the epidermis (first-degree burns) or portions of the dermis (second-degree burns), but, with prolonged exposure, burns may involve the entire dermis (third-degree burns) or extend beneath into fat, muscle, and bone. Burn injuries induce a systemic hypermetabolic response, resulting in inflammation, immune system compromise, catabolism, and endocrine dysfunction. Early excision and grafting have been demonstrated to reduce inflammation and decrease the risks of infection, wound sepsis, and multi-organ failure.

Original languageEnglish (US)
Title of host publicationEssentials of Trauma Anesthesia
PublisherCambridge University Press
Pages253-262
Number of pages10
ISBN (Print)9781139061339, 9781107602564
DOIs
StatePublished - Jan 1 2012

Fingerprint

Anesthetics
Burns
Wounds and Injuries
Resuscitation
Body Surface Area
Dermis
Inhalation
Hot Temperature
Inflammation
Patient Care Team
Mortality
Debridement
Wound Infection
Operating Rooms
Carbon Monoxide
Epidermis
Smoke
Accidents
Intensive Care Units
Immune System

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Pierre, E. J., & Varon, A. J. (2012). Anesthetic management of the burn patient. In Essentials of Trauma Anesthesia (pp. 253-262). Cambridge University Press. https://doi.org/10.1017/CBO9781139061339.020

Anesthetic management of the burn patient. / Pierre, Edgar J.; Varon, Albert J.

Essentials of Trauma Anesthesia. Cambridge University Press, 2012. p. 253-262.

Research output: Chapter in Book/Report/Conference proceedingChapter

Pierre, EJ & Varon, AJ 2012, Anesthetic management of the burn patient. in Essentials of Trauma Anesthesia. Cambridge University Press, pp. 253-262. https://doi.org/10.1017/CBO9781139061339.020
Pierre EJ, Varon AJ. Anesthetic management of the burn patient. In Essentials of Trauma Anesthesia. Cambridge University Press. 2012. p. 253-262 https://doi.org/10.1017/CBO9781139061339.020
Pierre, Edgar J. ; Varon, Albert J. / Anesthetic management of the burn patient. Essentials of Trauma Anesthesia. Cambridge University Press, 2012. pp. 253-262
@inbook{6590ba7c222c40e88c750ec8a9b3d796,
title = "Anesthetic management of the burn patient",
abstract = "The management of thermally injured patients is challenging. Effective treatment is mandatory at the scene of the accident, in the resuscitation bay, the operating room (OR), and the intensive care unit (ICU). Anesthesiologists trained in resuscitation, intraoperative management, and postoperative support are essential members of the burn patient management care team. As our surgical colleagues concentrate on surgical diagnosis and therapy, the anesthesiologist must also provide anesthesia and preserve vital organ functions. Severe burn injuries, defined as burns exceeding 40{\%} of total body surface area (TBSA), occur in approximately 35,000 patients annually. In 15 to 30{\%} of fire victims, smoke inhalation and carbon monoxide intoxication complicate the burn injury. Risk factors associated with mortality include: • Age greater than 60 years • More than 40{\%} of body surface area (BSA) burned • Presence of inhalation injury Mortality can be predicted as 0.3{\%}, 3{\%}, 33{\%}, or approximately 90{\%}, depending on whether zero, one, two, or three of these risk factors are present, respectively. Pathophysiology A thorough knowledge of the pathophysiologic changes that accompany burn injuries facilitates anesthetic management during the three phases of burn injury: 1. Early resuscitation 2. Debridement and grafting 3. Reconstructive phases The pathophysiology of thermal injury is related to the initial distribution of heat within the skin. Most burns involve only the epidermis (first-degree burns) or portions of the dermis (second-degree burns), but, with prolonged exposure, burns may involve the entire dermis (third-degree burns) or extend beneath into fat, muscle, and bone. Burn injuries induce a systemic hypermetabolic response, resulting in inflammation, immune system compromise, catabolism, and endocrine dysfunction. Early excision and grafting have been demonstrated to reduce inflammation and decrease the risks of infection, wound sepsis, and multi-organ failure.",
author = "Pierre, {Edgar J.} and Varon, {Albert J.}",
year = "2012",
month = "1",
day = "1",
doi = "10.1017/CBO9781139061339.020",
language = "English (US)",
isbn = "9781139061339",
pages = "253--262",
booktitle = "Essentials of Trauma Anesthesia",
publisher = "Cambridge University Press",

}

TY - CHAP

T1 - Anesthetic management of the burn patient

AU - Pierre, Edgar J.

AU - Varon, Albert J.

PY - 2012/1/1

Y1 - 2012/1/1

N2 - The management of thermally injured patients is challenging. Effective treatment is mandatory at the scene of the accident, in the resuscitation bay, the operating room (OR), and the intensive care unit (ICU). Anesthesiologists trained in resuscitation, intraoperative management, and postoperative support are essential members of the burn patient management care team. As our surgical colleagues concentrate on surgical diagnosis and therapy, the anesthesiologist must also provide anesthesia and preserve vital organ functions. Severe burn injuries, defined as burns exceeding 40% of total body surface area (TBSA), occur in approximately 35,000 patients annually. In 15 to 30% of fire victims, smoke inhalation and carbon monoxide intoxication complicate the burn injury. Risk factors associated with mortality include: • Age greater than 60 years • More than 40% of body surface area (BSA) burned • Presence of inhalation injury Mortality can be predicted as 0.3%, 3%, 33%, or approximately 90%, depending on whether zero, one, two, or three of these risk factors are present, respectively. Pathophysiology A thorough knowledge of the pathophysiologic changes that accompany burn injuries facilitates anesthetic management during the three phases of burn injury: 1. Early resuscitation 2. Debridement and grafting 3. Reconstructive phases The pathophysiology of thermal injury is related to the initial distribution of heat within the skin. Most burns involve only the epidermis (first-degree burns) or portions of the dermis (second-degree burns), but, with prolonged exposure, burns may involve the entire dermis (third-degree burns) or extend beneath into fat, muscle, and bone. Burn injuries induce a systemic hypermetabolic response, resulting in inflammation, immune system compromise, catabolism, and endocrine dysfunction. Early excision and grafting have been demonstrated to reduce inflammation and decrease the risks of infection, wound sepsis, and multi-organ failure.

AB - The management of thermally injured patients is challenging. Effective treatment is mandatory at the scene of the accident, in the resuscitation bay, the operating room (OR), and the intensive care unit (ICU). Anesthesiologists trained in resuscitation, intraoperative management, and postoperative support are essential members of the burn patient management care team. As our surgical colleagues concentrate on surgical diagnosis and therapy, the anesthesiologist must also provide anesthesia and preserve vital organ functions. Severe burn injuries, defined as burns exceeding 40% of total body surface area (TBSA), occur in approximately 35,000 patients annually. In 15 to 30% of fire victims, smoke inhalation and carbon monoxide intoxication complicate the burn injury. Risk factors associated with mortality include: • Age greater than 60 years • More than 40% of body surface area (BSA) burned • Presence of inhalation injury Mortality can be predicted as 0.3%, 3%, 33%, or approximately 90%, depending on whether zero, one, two, or three of these risk factors are present, respectively. Pathophysiology A thorough knowledge of the pathophysiologic changes that accompany burn injuries facilitates anesthetic management during the three phases of burn injury: 1. Early resuscitation 2. Debridement and grafting 3. Reconstructive phases The pathophysiology of thermal injury is related to the initial distribution of heat within the skin. Most burns involve only the epidermis (first-degree burns) or portions of the dermis (second-degree burns), but, with prolonged exposure, burns may involve the entire dermis (third-degree burns) or extend beneath into fat, muscle, and bone. Burn injuries induce a systemic hypermetabolic response, resulting in inflammation, immune system compromise, catabolism, and endocrine dysfunction. Early excision and grafting have been demonstrated to reduce inflammation and decrease the risks of infection, wound sepsis, and multi-organ failure.

UR - http://www.scopus.com/inward/record.url?scp=84924703635&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84924703635&partnerID=8YFLogxK

U2 - 10.1017/CBO9781139061339.020

DO - 10.1017/CBO9781139061339.020

M3 - Chapter

SN - 9781139061339

SN - 9781107602564

SP - 253

EP - 262

BT - Essentials of Trauma Anesthesia

PB - Cambridge University Press

ER -