الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 160 |  |  |
| | | from | 160 | | |
Abstract
Burn injuries are challenge both to patients and members of the burn team. Anesthesiologists are involved throughout the resuscitation and recovery phases of the burn patient in the emergency department, burn intensive care unit and operating room. Burn injuries are most commonly divided into four categories; each requiring slightly different treatment for optimal healing, but all initiate a hypermetabolic inflammatory response. The most common of the four categories of burn injury are flame (fire/thermal/scalding-steam/liquid) treatment depends heavily on the extent of injury to the skin. Electrical burns can be the most challenging to be treated secondary to associated CNS,myocardial, renal, and tissue destruction around bones. The last two categories most commonly mentioned are chemical burns and radiation burns. The safe anesthetic management of complex burn injuries requires an understanding of the obligatory pathophysiological changes and current treatment options. The anesthetic team must have collectively special skills in resuscitation, airway management, critical care procedures, care of small children and access to expert advice in the management of non-burns co-morbidity. As an immediate response to severe burn injury, the metabolic rate decreases acutely. Cardiac output generally decreases to approximately 50–60% of the normal resting value. A few days after the initial injury, and correlating with effective fluid resuscitation, the metabolic rate begins to increase, usually peaking between 7th and 12th day after the thermal injury; the peak may achieve a value of up to twice normal, and is usually proportional to the percentage TBSA involved. This hypermetabolic state results in severe catabolic protein loss, impaired immune function, and delayed wound healing. Furthermore, the increased oxygen demand must be matched with adequate supply. For a severely burned individual, as for any acute trauma victim, the initial care provided involves special attention to the airway to ensure that it is patent and that oxygenation, ventilation, and circulation are not compromised. In addition to standard indications and considerations for Endo-tracheal intubation, a burn victim requires additional considerations due to early upper airway swelling, inhalation injury, and carbon monoxide poisoning. The decision to intubate must be made early and is preferable to cricothyroidotomy in the edematous and swollen neck. Sepsis remains a common cause of death in patients who have sustained severe burn injury. Because of the unique metabolic and physiologic responses that follow thermal injury. During anesthesia there is a continual requirement to monitor the patient’s physiological state, to confirm correct equipment function, and to avoid patient awareness. Accepted recommendations state that the following monitoring devices are essential to the safe conduct of anesthesia: pulse oximetry, non-invasive blood pressure monitor, ECG and capnography. Securing central venous access before generalized tissue oedema obscures landmarks is preferable.
Objectives: This is an essay study to clarify the challenges that face the anesthetist while managing different cases of burn such as intravenous access, airway management, monitoring, resuscitation and perioperative management of burned patient.
Background: Burn injuries are challenge both to patients and members of the burn team. Anesthesiologists are involved throughout the resuscitation and recovery phases of the burn patient in the emergency department, burn intensive care unit and operating room. Burn injuries are most commonly divided into four categories; each requiring slightly different treatment for optimal healing, but all initiate a hypermetabolic inflammatory response. The most common of the four categories of burn injury are flame (fire/thermal/scalding-steam/liquid) treatment depends heavily on the extent of injury to the skin. Electrical burns can be the most challenging to be treated secondary to associated CNS,myocardial, renal, and tissue destruction around bones. The last two categories most commonly mentioned are chemical burns and radiation burns. The safe anesthetic management of complex burn injuries requires an understanding of the obligatory pathophysiological changes and current treatment options. The anesthetic team must have collectively special skills in resuscitation, airway management, critical care procedures, care of small children and access to expert advice in the management of non-burns co-morbidity. As an immediate response to severe burn injury, the metabolic rate decreases acutely. Cardiac output generally decreases to approximately 50–60% of the normal resting value. A few days after the initial injury, and correlating with effective fluid resuscitation, the metabolic rate begins to increase, usually peaking between 7th and 12th day after the thermal injury; the peak may achieve a value of up to twice normal, and is usually proportional to the percentage TBSA involved. This hypermetabolic state results in severe catabolic protein loss, impaired immune function, and delayed wound healing. Furthermore, the increased oxygen demand must be matched with adequate supply. For a severely burned individual, as for any acute trauma victim, the initial care provided involves special attention to the airway to ensure that it is patent and that oxygenation, ventilation, and circulation are not compromised. In addition to standard indications and considerations for Endo-tracheal intubation, a burn victim requires additional considerations due to early upper airway swelling, inhalation injury, and carbon monoxide poisoning. The decision to intubate must be made early and is preferable to cricothyroidotomy in the edematous and swollen neck. Sepsis remains a common cause of death in patients who have sustained severe burn injury. Because of the unique metabolic and physiologic responses that follow thermal injury. During anesthesia there is a continual requirement to monitor the patient’s physiological state, to confirm correct equipment function, and to avoid patient awareness. Accepted recommendations state that the following monitoring devices are essential to the safe conduct of anesthesia: pulse oximetry, non-invasive blood pressure monitor, ECG and capnography. Securing central venous access before generalized tissue oedema obscures landmarks is preferable