There have been a lot of strides in burn care in recent decades. Attention has moved away from survival to making burn patients more comfortable as they heal from major trauma.

If you or a family member has suffered burn injuries in an accident caused by negligence, you have the right to compensation. Reach out to our experienced injury lawyers for free, friendly advice on pursuing a personal injury claim. Call us at (916) 921-6400.

Anesthesia is the art of keeping the patient comfortable during the often several surgeries and multiple dressing changes that need to occur as part of the healing process.

The treatment of burn patients requires a multidisciplinary team of surgeons, nutritionists, internists, respiratory therapy providers, nurses, rehabilitation providers, and anesthesiologists. The anesthesiologists and anesthetists become the experts in gaining vascular access, airway management, lung care, and support of the body through fluid and electrolyte management, along with their primary expertise in alleviating pain and altering consciousness during surgery.

There are several challenges the anesthesia team faces when dealing with a burn patient during surgery. Some of these include:

• Lung problems/insufficiency
• Airway compromise
• Other injuries
• Changed mental status
• Rapid blood loss
• Limited IV access
• Low hemoglobin
• Swelling
• Heart arrhythmias
• Poor temperature regulation
• Kidney problems
• Poor immune system
• Infection or sepsis

People with severe burns are at their most resilient to withstand surgery shortly after being resuscitated from their burn. As time goes on, factors surrounding the burn cause the patient’s health to deteriorate, so it is essential to do the necessary surgery within a narrow window of the best health possible.

Anesthesiologists must look at the following things before bringing the patient to the operating room for surgery. They need to look at the patient’s age as older people tend to need special care during surgery. They need to know the extent of the burn to gauge the amount of fluid the patient will need in surgery—the need to know the type of burn and whether there has been a lung or inhalation injury.

The size of the burn matters when it comes to anesthesia, and large burns set up an inflammatory response that affects the function of all the body organs, including the liver and kidneys. If the burns are deep, there will be more blood loss in surgery and fluid loss. Blood products might be immediately necessary to compensate for the loss incurred during debridement surgery.

The airway must be clear and be able to pass an endotracheal tube during surgery. The lungs may be damaged due to smoke inhalation, and the anesthesiologist needs to be prepared for these burn injuries. Sometimes, using an endotracheal tube unnecessarily because of suspected lung damage is dangerous because it can further inflame upper airway tissues. The anesthesiologist must weigh these factors in the management of the perioperative patient.

The burn can severely affect circulation. Shock can develop from the poor cardiac output and increased resistance to the blood flow in the arteries. The tissues don’t get enough circulation—fluid shifts from the bloodstream to lymph and body tissues. Severe burns can suppress the heart’s function, further contributing to shock development. The patient may need large volumes of fluid by IV to make up for fluid shifts and fluid loss.

Resuscitation by the anesthetist begins with giving enough fluids and ends with making sure the patient is getting enough oxygen. Usually, giving fluids like IV Lactated Ringer’s solution is necessary, but some patients will need blood products or protein-containing fluid. More fluid is required if the patient has the following situations:

• Delayed resuscitation
• Lung injury
• Crushing injury
• Other injuries/trauma
• Large full-thickness burns

Patients tend to have a lot of swelling around and in the burned area, and this is fluid that needs to be replaced back into the bloodstream so the individual doesn’t suffer from shock. Doctors need to follow the kidneys’ amount of urine to gauge whether the fluid resuscitation is adequate. If not enough urine is being put out, the patient isn’t getting enough fluid.

Severe burns can cause the kidneys to fail, which further complicates matters. Anesthesiologists must adjust the amount of medication given depending on the burn circumstances. The kidneys don’t function well in severe burns, so less medicine is given if the patient is more sensitive to succinylcholine. A patient can die of complications of too much muscle relaxant during anesthesia.

The anesthesiologist is responsible for the patient’s well-being in the operating room. The airway must be highly secure with an endotracheal tube and might have to be secured while the patient is lying on their stomach. This requires special care during intubation and turning the patient onto their stomach. Unique ways of tying the endotracheal tube in place need to be employed so it doesn’t become dislodged during the surgery. The tube may need to be passed through the nose instead of the mouth.

Even with large surface areas of the body covered in burns, the patient needs to be monitored effectively during surgery. To measure arterial oxygen saturation, blood pressure and body temperature must be established and maintained during the operation. Sometimes, peripheral IVs are not possible, and the patient will need a central venous catheter instead. Other times, the IV must be placed directly through burned tissue. Arterial blood catheters might need to be in place so that the oxygenation of blood and blood pressure inside the arteries can be continually monitored.

As far as anesthetic agents go, sometimes less often used medications like ketamine may need to be used. This drug can induce anesthesia and maintain anesthesia and does not always require that the patient is on a ventilator. It can even be given intramuscularly for patients who do not have good IV access or are uncooperative during surgery. If an endotracheal tube is present, the patient can have the usually inhaled anesthetic agents during the surgical procedure. Opioids like morphine can be given before, during, and after surgery for pain control.

Blood transfusions may need to be given during surgery. Most experts believe blood transfusions should be if the hemoglobin has dropped to the 6-10 g/dl range. Patients with heart or lung problems need more blood transfusions at a higher hemoglobin concentration than regular patients. Ideally, blood should be given as the blood is being lost during surgery and not after the patient’s blood pressure and blood volume have diminished.

There are complications to giving too much blood. The blood can become too thin from a lack of platelets in the transfused blood, so excess bleeding occurs. Citrate used to preserve blood can reach toxic levels, and potassium shifts can occur, which can cause heart arrhythmias. The patient can become too cold if many cold blood products are given. The lungs can also fill with fluid if large amounts of blood are necessary. Blood transfusions also increase the risk of wound infection.

Watch the YouTube video below to understand how anesthesia works during surgery. 

A severe burn is a catastrophe. Anyone who has a serious burn through the negligence of another should contact our experienced Sacramento injury lawyer. If you or a loved one has been seriously burned in an accident, call us for free, friendly advice at (916) 921-6400 or (800) 404-5400.

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Editor’s Note: This page has been updated for accuracy and relevancy [cha 5.20.22]

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