2. MAJOR PERIOPERATIVE CONCERN FOR BURN PATIENT
Age of the patient
Extent of burn injury
Mechanism of burn injury
Elapsed time from burn injury
Associated injuries
Inhalational injury
Adequacy of resuscitation
Airway patency
Difficult vascular access
Gastric statis
Altered drug responses
Altered mental status
Pain/Anxiety
Presence of organ dysfunction
Presence of infection
3.
4.
5.
6.
7.
8.
9. American Burn Life Support (ABLS) indications for early
intubation include:
Signs of airway obstruction (hoarseness, stridor, accessory respiratory
muscle use, sternal retraction)
Extent of the burn (total body surface area burn > 40%–50%)
Extensive and deep facial burns
Burns inside the mouth
Significant edema or risk for edema
Difficulty swallowing
Signs of respiratory compromise: inability to clear secretions,
respiratory fatigue, poor oxygenation or ventilation
Decreased level of consciousness where airway protective reflexes are
impaired
Anticipated patient transfer of large burn with airway issue without
qualified personnel to intubate en route
10. Onah’s classification of postburn contracture of
the neck
1) Mild anterior contracture
limited extension, full flexion to normal anatomic position
skin, subcutaneous tissue involved
2) Moderate anterior contracture
extension causes significant pull at uninvolved lower lip
skin, subcutaneous tissue involved
3) Severe anterior contracture
restricted extension, skin, subcutaneous tissue and strap muscles involved
4) Posterior contracture
neck held in extension, skin subcutaneous tissue involved
11. Problems in patients with healed burn
1) Distorted and reduced nasal opening
2) Narrow nasal passage
3) Distorted and reduced mouth opening
4) Restricted neck movement
5) Stiff submandibular space
6) Scar and contracture in front of neck
7) Larynx may be shifted from midline
8) Decreased oropharyngeal space
9) Distortion in anatomic alignment of oro-pharynx
pharynx and trachea
10) Cervical spine distortion
11) Fixed flexion neck deformity
12. POINTS TO BE KEPT IN MIND DURING PAC
1) Type of surgery
2) Time of burn and its duration
3) Cause of burn
4) Extent of burn
5) Assessment of airway
6) Technique of choice of anaesthesia
7) Starting IV lines
16. AIRWAY MANAGEMENT
Plan A- awake nasal FB/ Oral FB
Plan B- Awake video laryngoscopy
Plan C- SGAD under inhalational
Plan D- Release of scar under Ketamine
Plan E – Tumescent anaesthesia
17. AWAKE FIBREOPTIC NASAL INTUBATION
PREPARATION- ‘ADD TSP’
Adequate explanation of need of procedure
Decongestion of nasal passage using vasoconstrictors
Drying up secretions by using glycopyrrolate
Topicalisation of upper airway by nebulization, gargle and local spray
Sedation and anxiolysis
Preoxygenation-Perioxygenation
33. TROUBLE SHOOTING DURING FIBREOPTIC
INTUBATION
Blurred view
Can not identify larynx
Bleeding
Can not remove fibreoptic
Can not pass tube
34.
35.
36.
37. TUMESCENT LA
Solution for tumescent contains lignocaine, adrenaline, hyaluronidase,
and saline
FORMULA: 25ml of 2% lignocaine + hyaluronidase 1-2ml + 1 ml of 1 in
1,00,000 adrenaline + distilled water to a total volume of 100 ml.
Tumescent LA infiltrated along with incision line and into surrounding
areas.
The associated vasoconstriction was so complete that there was virtually
no blood loss during surgery.
40. MUSCLE RELAXANT IN BURN PATIENTS
Musculoskeletal Injury in Burns :-
Damaged muscle →↑ acetylcholine
receptor density + Extra Junctional Receptors
↓
• ↓ sensitivity to nondepolarizing muscle relaxants
• potentially fatal elevations of K+ in response to succinylcholine.
Avoid succinylcholine after 24 hrs to 48 hrs Postburn and for at least 2 year
thereafter.
41. ROLE OF KETAMINE IN BURNS
1) Hemodynamic stability
2) Airway patency
3) Preserves hypoxic and hypercapnic responses
4) Decreases airway resistance