Anaesthesia for Burns
Apr 23, 2025
Where there’s smoke… π©Ίπ₯
Anaesthesia for major burns is a high-stakes, high-intensity challenge that demands the full capacity of the anaesthetic team — from stabilisation of the patient to airway management, analgesia π, and ongoing care in the perioperative environment. Here we explore the key considerations for anaesthetic management of burns patients and the critical importance of teamwork π€, vigilance, and early intervention in supporting this extremely vulnerable patient cohort.
Airway
Burns patients often require immediate airway management, which can rapidly become complex due to limited mouth opening, airway and facial oedema, and distorted anatomy. Considerations for intubation include the use of a videolaryngoscope, awake fibre-optic intubation, and the potential for emergency cricothyroidotomy or tracheostomy.
Breathing
These patients are at high risk of pulmonary complications, including oedema, wheezing, hoarseness π, sputum production, tachypnoea, and desaturation. Ongoing monitoring is essential.
Circulation / Fluid Resuscitation
“Burn shock” is characterised by hypoperfusion and hypovolaemia, typically within the first 24 hours. Close monitoring of organ perfusion is required, with aggressive fluid resuscitation to prevent further injury. Bleeding, evaporative losses, and systemic inflammatory responses further impair perfusion. Large-bore IV access π is critical.
Monitoring
Intraoperative monitoring can be challenging depending on injury location. Pulse oximetry may need to be taken from the nose, ear, or tongue. Arterial gases may be required.
Temperature monitoring π‘οΈ is vital due to the high risk of hypothermia.
If limbs are affected, non-invasive BP monitoring may not be feasible — invasive methods may be needed. ECG electrodes may not adhere to burnt tissue; alternatives include needle electrodes or skin staples.
Analgesia
Burns patients require high levels of analgesia and are often complex to manage. Opioids remain the mainstay, but ketamine is a useful opioid-sparing alternative that also offers cardiovascular stability β€οΈ.
Anaesthesia for major burns is dynamic and complex, requiring vigilance, ongoing reassessment, and strong teamwork π€, planning, and communication to deliver the best possible outcomes for these vulnerable patients.
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References:
Edelman, D., Konstantatos, A. (2024) Burns: Resuscitation and Anaesthetic management. WFSA.https://resources.wfsahq.org/atotw/burns-resuscitation-and-anaesthetic-management/
Mcgovern, C., Puxty, K., Paton, L. (2022). Major burns: part 2. Anaesthesia, intensive care and pain management. BJA education. V22(4) pp 138-145. DOI: 10.1016/j.bjae.2022.01.001
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