Difference between revisions of "Burn wound debridement"

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=== Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> ===
 
=== Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> ===
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* Make sure OR is warm
  
 
=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> ===
 
=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> ===
  
 
=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> ===
 
=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> ===
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* Use of regional anesthesia may be limited by area of injury and risk of infection
  
 
== Intraoperative management ==
 
== Intraoperative management ==
  
 
=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> ===
 
=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> ===
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* 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. 
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** EKG:  If thorax is severely burned, may consider using skin staples attached to crocodile clips
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** Pulse ox:  Consider alternative sites (i.e. ears, nose, lip, tongue)
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** BP:  May need arterial line if no suitable location for cuff
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* Given high degree of insensible losses, important to track fluid status
  
 
=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> ===
 
=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> ===
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* Avoid succinycholine outside 24 hours from injury, given risk for fatal hyperkalemia
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** Risk of hyperkalemia can persist for up to 2 years after a burn injury
  
 
=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> ===
 
=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> ===

Revision as of 16:51, 1 June 2021

Burn wound debridement
Anesthesia type
Airway
Lines and access
Monitors
Primary anesthetic considerations
Preoperative
Intraoperative
Postoperative


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[1].

Preoperative management

Patient evaluation

System Considerations
Neurologic
Cardiovascular
Respiratory
Gastrointestinal
Hematologic
Renal
Endocrine
Other

Labs and studies

Operating room setup

  • Make sure OR is warm

Patient preparation and premedication

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

Positioning

Maintenance and surgical considerations

Emergence

Postoperative management

Disposition

Pain management

Potential complications

Procedure variants

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

References

  1. Wang, Cynthia (2014-07-17). "Management of Burns and Anesthetic Implications". Anesthesia for Trauma: 291–319. doi:10.1007/978-1-4939-0909-4_14. PMC 7121311.