Anesthesia for burned patients

Anesthetic management of the patient with major burn injuries presents numerous challenges. During the acute resuscitation phase, massive crystalloid infusions may be required. Anatomical distortions make airway management and vascular access difficult. With time, pathophysiological changes in cardiovascular function range from initial hypovolemia and impaired perfusion to a hyperdynamic circulation and hypermetabolic state. Pharmacological support of the circulation may be needed. These and other changes profoundly alter response to anesthetic drugs. Effective anesthetic management will depend on knowledge of the continuum of pathophysiological changes, technical skills, proper planning, and availability of proper resources. A team approach is necessary, keeping in mind that perioperative management not only depends on the surgical plan, but also should be compatible with ICU management and goals. This requires close communication with other members of the burn care team, which is one of the most important principles of effective anesthetic management of these challenging patients.