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Anaesthesia: intraoperative management of patients with acute burn injury 

Anaesthesia: intraoperative management of patients with acute burn injury
Chapter:
Anaesthesia: intraoperative management of patients with acute burn injury
Author(s):

Lee C. Woodson

DOI:
10.1093/med/9780199699537.003.0015
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date: 27 November 2020

Choice of anaesthetic technique for major burn surgery is determined by the patient’s anatomical and physiologic status and the surgical plan. Burns involving the face and neck can make tracheal intubation by direct laryngoscopy difficult or impossible and require an alternative technique. Cutaneous burns may impair application of monitors such as pulse oximetry and ECG. Vascular access and available blood products should be adequate to resuscitate from massive hemorrhage and treat coagulopathy. Difficult peripheral venous access may require central venous cannulation and arterial cannulation may be required for hemodynamic monitoring. An important goal for intraoperative fluid management is to minimize the amount of crystalloid administered. Fluid replacement of shed blood is complex and requires attention to multiple physiological variables. Burn patients are intolerant of hypothermia and vigorous means are necessary to maintain core temperature. Pain associated with burn surgery is intense and a multimodal plan for its control should be initiated intraoperatively.

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