Burn wound debridement

Burn wound debridement

Anesthesia type
Airway
Lines and access
Monitors
Primary anesthetic considerations
Preoperative
Intraoperative
Postoperative
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Burn wound debridement is a surgical procedure performed for the management of burn injuries. While epidermal burns typically only require supportive therapy, deeper burns often require surgical intervention. 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
Pulmonary
Gastrointestinal
Hematologic
Renal
Endocrine
Other

*These patients have often had multiple prior anesthetics for debridement. Carefully review previous anesthetic records, while recognizing that anesthetic requirements may increase over time.

Operating room setup

• Make sure OR is warm, have warming blankets, forced air warming, and/or warmed fluids.

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
• Temperature monitoring is critical

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
• Airway management can be complicated by burns to head/neck region.
  • Over time, face of neck contractures can cause the airway anatomy to be distorted.

Positioning

• Largely depends on the site of the burn injury
• Pay extra careful attention to positioning on burned areas
• Extra padding on burned areas

Maintenance and surgical considerations

• Standard maintenance
• May have developed tolerance to opioids
• Blood loss can be significant
  • Frequently check Hgb/Hct
  • To minimize blood loss, surgeon may infiltrate with tumescent solution that contains vasoconstrictors. This may cause systemic inject and fluid overload
• Carefully monitor temperature
• Carefully monitor fluid status

Procedure variants

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