[Problems caused by anesthesia of patients with severe burns].
The treatment of severe burns requires repeated and various surgical procedures under general anaesthesias. Requirements differ according to the evolution phase of the burnt lesion. Three first post-traumatic days are marked by a major oedema and a large haemodynamic instability. Hypovolemia during 12 to 24 hours is followed by an hyperkinetic phase. The secondary period can last several weeks to several months before the cutaneous recovery is complete. Septic risk is then major and dénutrition constant. Problems raised by surgery differ according to the type of surgery: early excision of deep bums, bath therapy, skin graft, dressing. These procedures are often haemorrhagic and painful. Thermal status is constantly threatened. This type of pathology interferes with the pharmacology of anaesthetic drugs. Hypoprotidemia and change of protein-binding modify drug kinetics. Continuous use of opiates and sedatives is source of tolerance and tachyphylaxis. The number of acetylcholine receptors is increased, contraindicating the use of depolarizing muscle relaxants and often induces a resistance to the nondepolarizing muscle relaxants. The knowledge of these alteration leads to discuss indications of anaesthetics, analgesics and muscle relaxants most frequently used in these patients. During anaesthesia the positioning of the patient takes into account the surgical needs. Hypothermia prevention is mandatory. Peroperative resuscitation is dominated by maintenance of haemodynamic balance, compensation of hydroelectrolytic and blood losses, treatment of septic complications. Should be the same who has in change the patient in the intensive care unit.
Bertin-Maghit
M
M
Centre Universitaire de Réanimation, Hôpital Edouard-Herriot, Lyon.
Gueugniaud
P Y
PY
Bouchard
C
C
Petit
P
P
D000768:Anesthesia, General / Q000379:methods*; D000777:Anesthetics / Q000008:administration & dosage; D001452:Balneology; D002056:Burns / Q000503:physiopathology / Q000628:therapy*; D003646:Debridement; D006801:Humans; D007430:Intraoperative Care; D007649:Ketamine / Q000008:administration & dosage; D015742:Propofol / Q000008:administration & dosage; D012769:Shock / Q000517:prevention & control; D016038:Skin Transplantation
D000777:Anesthetics; D007649:Ketamine; D015742:Propofol
Problèmes posés par l'anesthésie du brûlé grave.