"The burns patient challenges the anaesthetist twice: acutely, as a shocked patient with an airway that is closing; and later, as a hypermetabolic, contracted patient for repeated excision and grafting. The two phases demand different plans — but both punish hypothermia, under-resuscitation and a casual airway."
How to use this topic — CritCare.in.Anaesthesia for the Burns Patient
- The acute burn (hours–days) — a resuscitation problem: a threatened airway (thermal/inhalation injury), massive capillary leak & hypovolaemia, carbon-monoxide/cyanide toxicity and the need for escharotomy. This is the "ebb" (hypovolaemic) phase.
- The healing / contracted burn (weeks–months) — a hypermetabolic patient presenting for repeated excision, split-skin grafting and contracture release, with a difficult airway from neck/face contractures, altered drug handling and major intra-operative blood & heat loss. This is the "flow" (hypermetabolic) phase.
- Secure the airway early; resuscitate to a urine output, not a formula; from ~24–48 h to ~1–2 years avoid suxamethonium (lethal hyperkalaemia) and expect resistance to non-depolarisers; and treat the burns patient as one who will lose heat, blood and protein faster than anyone else on your list.
Depth, TBSA & Pathophysiology
Burn depth classification, rule of 9s / Lund–Browder, Jackson's three zones and the ebb → flow (hypermetabolic) response.
🚑02 · RESUSCITATIONAcute ABCDE & Fluids
The primary survey, the Parkland formula, inhalation injury, CO & cyanide toxicity and escharotomy.
🫁03 · AIRWAYThe Burns Difficult Airway
Early intubation in inhalation injury; the contracture airway (↓ mouth opening, ↓ neck movement) and a planned, tubes-ready approach.
💊04 · PHARMACOLOGYSuxamethonium & Altered Drugs
Suxamethonium hyperkalaemia, the safe window & timeline, NDMR resistance, and altered PK in the hypermetabolic patient.
🔪05 · INTRA-OPExcision, Grafting & Contracture
Preventing hypothermia, massive blood loss, adrenaline swabs, monitoring the burnt patient and positioning for donor sites.
🎓06 · PEARLSRecovery, Mistakes & References
Awake vs delayed extubation, multimodal analgesia (opioid tolerance, ketamine, gabapentinoids), common mistakes and references.