Anesthesia for patients with acute burn injuries

Remarkable advances continue to be made in the care of patients with major burn injuries. Early aggressive fluid resuscitation has dramatically improved initial survival. The development of specialized burn centers has allowed the concentration and coordination of resources needed to provide a multidisciplinary approach from the time of admission with the goal of not just maximizing survival but optimizing functional recovery as well [1]. Anesthetic management is an important part of this multidisciplinary approach. Anesthesia providers have highly developed skills and experience in airway management, pulmonary care, fluid and electrolyte management, vascular access, and pharmacological support of the circulation. These areas of clinical expertise are all central to the care of patients with major burn injuries. However, the effective use of this clinical expertise for the care of burn patients requires knowledge of the pathophysiological changes associated with burns and an understanding of the multidisciplinary approach to burn care [2]. To be effective, perioperative management should be compatible with overall goals and especially with ICU care. Patients with large acute burns present multiple challenges to anesthetic management (Table 1). Virtually all organ systems are affected by large burn injuries. These changes have an important influence on anesthetic management including not only drug selection and dosage but airway management, monitoring, fluid administration, sedation, and pain control. As a result, nearly every aspect of anesthetic care must include some adjustment to deal with pathophysiological changes due to the burns.