[Problems caused by anesthesia of patients with severe burns]. 1995

M Bertin-Maghit, and P Y Gueugniaud, and C Bouchard, and P Petit
Centre Universitaire de Réanimation, Hôpital Edouard-Herriot, Lyon.

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.

UI MeSH Term Description Entries
D007430 Intraoperative Care Patient care procedures performed during the operation that are ancillary to the actual surgery. It includes monitoring, fluid therapy, medication, transfusion, anesthesia, radiography, and laboratory tests. Care, Intraoperative
D007649 Ketamine A cyclohexanone derivative used for induction of anesthesia. Its mechanism of action is not well understood, but ketamine can block NMDA receptors (RECEPTORS, N-METHYL-D-ASPARTATE) and may interact with sigma receptors. 2-(2-Chlorophenyl)-2-(methylamino)cyclohexanone,CI-581,Calipsol,Calypsol,Kalipsol,Ketalar,Ketamine Hydrochloride,Ketanest,Ketaset,CI 581,CI581
D002056 Burns Injuries to tissues caused by contact with heat, steam, chemicals (BURNS, CHEMICAL), electricity (BURNS, ELECTRIC), or the like. Burn
D003646 Debridement The removal of foreign material and devitalized or contaminated tissue from or adjacent to a traumatic or infected lesion until surrounding healthy tissue is exposed. (Dorland, 27th ed) Debridements
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000768 Anesthesia, General Procedure in which patients are induced into an unconscious state through use of various medications so that they do not feel pain during surgery. Anesthesias, General,General Anesthesia,General Anesthesias
D000777 Anesthetics Agents capable of inducing a total or partial loss of sensation, especially tactile sensation and pain. They may act to induce general ANESTHESIA, in which an unconscious state is achieved, or may act locally to induce numbness or lack of sensation at a targeted site. Anesthetic,Anesthetic Agents,Anesthetic Drugs,Anesthetic Effect,Anesthetic Effects,Agents, Anesthetic,Drugs, Anesthetic,Effect, Anesthetic,Effects, Anesthetic
D001452 Balneology Therapy by various hot or warm baths in natural mineral waters, spas, or "cures". It includes not only bathing in, but also drinking the waters, but it does not include whirlpool baths (HYDROTHERAPY). Balneotherapy
D012769 Shock A pathological condition manifested by failure to perfuse or oxygenate vital organs. Circulatory Collapse,Circulatory Failure,Hypovolemic Shock,Collapse, Circulatory,Failure, Circulatory,Shock, Hypovolemic
D015742 Propofol An intravenous anesthetic agent which has the advantage of a very rapid onset after infusion or bolus injection plus a very short recovery period of a couple of minutes. (From Smith and Reynard, Textbook of Pharmacology, 1992, 1st ed, p206). Propofol has been used as ANTICONVULSANTS and ANTIEMETICS. Disoprofol,2,6-Bis(1-methylethyl)phenol,2,6-Diisopropylphenol,Aquafol,Diprivan,Disoprivan,Fresofol,ICI-35,868,ICI-35868,Ivofol,Propofol Abbott,Propofol Fresenius,Propofol MCT,Propofol Rovi,Propofol-Lipuro,Recofol,2,6 Diisopropylphenol,ICI 35,868,ICI 35868,ICI35,868,ICI35868

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