Anesthesia for Burned Patients

Woodson, Lee C.; Sherwood, Edward R.; Kinsky, Michael P.; Talon, Mark; Martinello, Caroline; Woodson, Sue M.

doi:10.1016/b978-0-323-47661-4.00013-7

Cited by 15 publications

(26 citation statements)

References 176 publications

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“…Rapid intravascular volume replenishment is vital. Delayed or inadequate fluid replacement results in hypovolemia, tissue hypoperfusion, shock, and multiple organ failure [10,11]. With extensive debridement and bleeding and when it is difficult to apply BP cuff, an arterial line is required for continuous BP measurement, and sampling.…”

Section: Discussionmentioning

confidence: 99%

Anesthetic management of a single ventricle pediatric patient with a major burn injury, case report

Mahmoud¹,

Aboalfaraj

Almalki

et al. 2020

Egyptian Journal of Anaesthesia

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Background: Glenn procedure is a Palliative surgical procedure performed as a step of staged repair for patients with single ventricle such as tricuspid atresia and hypoplastic left heart syndrome. It is usually performed at about three to six months of age, directs systemic venous blood directly from the superior vena cava to the pulmonary circulation. A significant burn injury affects almost all organs. Understanding the complex and pathophysiological responses in the early and late phases of injury is imperative to provide care in the acute and perioperative period. Large airway and lung edema can occur rapidly and unpredictably after burn. Hemodynamics changes in the early phase of severe burn injury are characterized by a reduction in cardiac output and increased systemic and pulmonary vascular resistance. Case Summary: We report the management of a single ventricle patient with its challenges and unique consideration and major burn with its problems. She underwent serial debridement, extensive skin grafting to all burn areas. The patient had hemoglobin of 8.7 g/dl, she was on dopamine infusion to maintain blood pressure which was difficult to measure by BP cuff, the extremities were not an option to use as monitoring sites. Upon arrival, her oxygen saturation (SpO2) was being monitored with a disposable pulse oximetry sensor through the ear lobule, at times monitoring was disrupted and disappeared. We managed to use an oral airway to measure oxygen saturation through soft palate successfully and after transfusion we could wean off inotropic support. Conclusion: Patients with Glenn shunt whose acceptable oxygen saturation is 75-80% need hemoglobin level above 13 g/dl. Measurements of capillary density using reflectance oximetry through the soft palate provide very reliable SpO2 measurements.

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Section: Discussionmentioning

confidence: 99%

Anesthetic management of a single ventricle pediatric patient with a major burn injury, case report

Mahmoud¹,

Aboalfaraj

Almalki

et al. 2020

Egyptian Journal of Anaesthesia

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“…Pneumonia is a severe infectious respiratory illness that causes inflammation of the pulmonary parenchyma [ 82 ]. Inhalation injury induces the risk of infection, causing lower respiratory tract diseases, especially pneumonia [ 83 , 84 ]. Burn-related pneumonia is linked to prolonged intubation and mechanical ventilation, and it involves up to 40% of patients who are intubated.…”

Section: Infectionsmentioning

confidence: 99%

Innate Immune System Response to Burn Damage—Focus on Cytokine Alteration

Sierawska

Małkowska

Taskin

et al. 2022

IJMS

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In the literature, burns are understood as traumatic events accompanied by increased morbidity and mortality among affected patients. Their characteristic feature is the formation of swelling and redness at the site of the burn, which indicates the development of inflammation. This reaction is not only important in the healing process of wounds but is also responsible for stimulating the patient’s innate immune system. As a result of the loss of the protective ability of the epidermis, microbes which include bacteria, fungi, and viruses have easier access to the system, which can result in infections. However, the patient is still able to overcome the infections that occur through a cascade of cytokines and growth factors stimulated by inflammation. Long-term inflammation also has negative consequences for the body, which may result in multi-organ failure or lead to fibrosis and scarring of the skin. The innate immune response to burns is not only immediate, but also severe and prolonged, and some people with burn shock may also experience immunosuppression accompanied by an increased susceptibility to fatal infections. This immunosuppression includes apoptosis-induced lymphopenia, decreased interleukin 2 (IL-2) secretion, neutrophil storm, impaired phagocytosis, and decreased monocyte human leukocyte antigen-DR. This is why it is important to understand how the immune system works in people with burns and during infections of wounds by microorganisms. The aim of this study was to characterize the molecular pathways of cell signaling of the immune system of people affected by burns, taking into account the role of microbial infections.

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“…La valoración de esta etapa debe enfocarse en los posibles tratamientos administrados para mitigar la respuesta hipermetabólica: beta-bloqueador, infusión de insulina, hipoglucemiantes orales, uso de anabólicos, alfa 2-agonistas, antibióticos, analgésicos, etcétera (7,8) . Así también, los procedimientos quirúrgicos son frecuentes con alto grado de sangrado, por lo que debe tomar precauciones solicitando un número adecuado de derivados sanguíneos, basado en un cálculo de sangrado esperado (Tabla 4) (9) .…”

Section: C) Evaluación Clínicaunclassified

“…Durante una quemadura grave, el abordaje de la VA es prácticamente obligatorio, y la dificultad estará asociada directamente al trauma y en modo secundario al tratamiento y a las complicaciones asociadas al abordaje continuo; es decir, que los pacientes gran quemado pasarán por vía aérea difícil (VAD) en algún momento del largo tratamiento (9,10) .…”

Section: Vía Aérea (Va) En Quemadurasunclassified

“…Siempre que sea necesaria la intubación de la VA de un gran quemado, pida ayuda de inicio y cuente con diversas habilidades para realizar intubación (despierto, retrógrada, etc.) así como de varios equipos para resolver las dificultades (cánulas de Guedel, laringoscopios con varios tipos de hojas, guía metálica, videolaringoscopio, fibroscopio) (4,9) .…”

Section: B) Manejo De Vía Aéreaunclassified

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