Burn wound debridement

Burn wound debridement

Anesthesia type
Airway
Lines and access
Monitors
Primary anesthetic considerations
Preoperative
Intraoperative
Postoperative
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The management of burn injuries is complex and these wound typically require aggressive debridement. Epidermal burns typically only require supportive therapy, but deeper burns often require more attention. Most deep partial thickness burns are best managed by excising the burnt tissue and grafting skin. Full-thickness burns >1cm² will almost always require require excision and grafting.

Preoperative management

Patient evaluation

System	Considerations
Neurologic
Cardiovascular
Respiratory
Gastrointestinal
Hematologic
Renal
Endocrine
Other

Operating room setup

• Make sure OR is warm

Regional and neuraxial techniques

• Use of regional anesthesia may be limited by area of injury and risk of infection

Intraoperative management

Monitoring and access

• Depending on the extent of the burn, monitoring can be difficult if access to the chest (ECG), arms (BP), and digits (pulse oximeter) is compromised.
  • EKG: If thorax is severely burned, may consider using skin staples attached to crocodile clips
  • Pulse ox: Consider alternative sites (i.e. ears, nose, lip, tongue)
  • BP: May need arterial line if no suitable location for cuff
• Given high degree of insensible losses, important to track fluid status

Induction and airway management

• Avoid succinycholine outside 24 hours from injury, given risk for fatal hyperkalemia
  • Risk of hyperkalemia can persist for up to 2 years after a burn injury

Procedure variants

	Variant 1	Variant 2
Unique considerations
Position
Surgical time
EBL
Postoperative disposition
Pain management
Potential complications