Pathophysiologic Changes Associated with Acute Burns

Patients with major acute burns present the anesthetist with numerous challenges involving every aspect of perioperative management. Anatomic distortions make airway control and vascular access technically difficult. The pathophysiologic cardiovascular response to burns ranges from initial hypovolemia and impaired perfusion to a hyperdynamic and hypermetabolic pattern that develops in the days following initial resuscitation. These and other changes affect every organ system and profoundly alter drug responses. Effective perioperative management depends on an understanding of the dynamic nature of pathophysiologic changes, technical skills, proper planning, and availability of resources. A team approach is necessary, keeping in mind that intraoperative management decisions must be consistent with intensive care unit management and goals. This requires close communication with all other members of the burn care team, which is an important principle of effective anesthetic management of patients with acute burns.