title: Acute and perioperative care of the burn-injured patient.
abstract: Care of burn-injured patients requires knowledge of the pathophysiologic changes affecting virtually all organs from the onset of injury until wounds are healed. Massive airway and/or lung edema can occur rapidly and unpredictably after burn and/or inhalation injury. Hemodynamics in the early phase of severe burn injury is characterized by a reduction in cardiac output and increased systemic and pulmonary vascular resistance. Approximately 2 to 5 days after major burn injury, a hyperdynamic and hypermetabolic state develops. Electrical burns result in morbidity much higher than expected based on burn size alone. Formulae for fluid resuscitation should serve only as guideline; fluids should be titrated to physiologic endpoints. Burn injury is associated basal and procedural pain requiring higher than normal opioid and sedative doses. Operating room concerns for the burn-injured patient include airway abnormalities, impaired lung function, vascular access, deceptively large and rapid blood loss, hypothermia, and altered pharmacology.
authors.affiliation: From the Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (E.A.B., E.S., J.A.J.M.); Shriners Hospitals for Children®, Boston, Massachusetts (E.A.B., E.S., J.A.J.M.); Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas (L.W.); and Shriners Hospitals for Children®, Galveston, Texas (L.W.).
authors.forename: Edward A
authors.initials: EA
authors.lastname: Bittner
authors.forename: Erik
authors.initials: E
authors.lastname: Shank
authors.forename: Lee
authors.initials: L
authors.lastname: Woodson
authors.forename: J A Jeevendra
authors.initials: JA
authors.lastname: Martyn
mesh_terms: D000758:Anesthesia; D002056:Burns / Q000628:therapy*; D002058:Burns, Electric / Q000628:therapy; D002059:Burns, Inhalation / Q000628:therapy; D006801:Humans; D059408:Pain Management / Q000379:methods; D019990:Perioperative Care / Q000379:methods*