I have a 100 slide power point lecture on anesthesia and burns. Three months out makes most of it easier as the physiology of the patient has largely returned to baseline, including the increased hepatic flow and increased volume of distribution that makes dosing of your meds a little more challenging.kifaru said:Question for those in the know;
how would you go about providing anesthesia for a patient who is 3 months s/p burn injury to the face and upper extremities. What are the unique challenges posed by burn patients?
The problem lies in the timing of the use of sux from the burn event and the variability you will encounter in different age groups and among patients with differing severity of burns. Unless you absolutely need to use it because of a probable difficult airway, a non-depolarizer is probably the safer choice.QuinnNSU said:Is sux truly contraindicated in an immediate burn? I've done some quick searching and found that within the first 4-6 hours after the burn injury, its ok to use succhinylcholine, the real danger is within day 1-4. I've spoken with burn attendings and they only have anecdotal evidence.
Fifteen years after the fact places you in no risk for hyperkalemia with sux. Unless you have a neuromuscular disease or suffered some type of paralysis from your injuries, you should be OK.Dr. J? said:Has anyone determined the length of time for which succinylcholine is contradindicated in a pt post-burn injury?
I am curious b/c I was told by an attending (from a NYC hospital whose name I cannot recall) that I was at risk for severe hyperkalemia if given succ d/t my PMx of a significant electrical burn when I was 12 (I am now a much older 2nd yr med student). She even mentioned that I should consider wearing a medical alert bracelet.
I was polite to her when she told me this (we were sharing dinner at a Japanese steak house), but thought she was totally full of $hit at the time (since it had been every bit of 15 yrs ago since my accident and I assumed my physiology would have returned to baseline). I attempted to search for articles on the subject when I returned from the conference, but could only find a few from the 1960-70's era which seemed to say the contraindication only lasted for a few months.
I would be interested in any comments y'all have about this, thanks.