Why isn't anesthesia used during burn wound debridement?

Started by Green Xenon1, January 25, 2010, 03:31:28 AM

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Green Xenon1


Burn victims must undergo a painful debridement of their wounds in order to prevent infection. Normally, they are given morphine and other non-anesthetic pain-killers. Sadly, this does not work. They still yell in pain during the operation, which is why they have to be housed seperately from other patients.

Why aren't the burn patients given anesthesia [local or general] prior to the operation? Is there a safety issue with anesthetics?




Burn victims definitely deserve adequate pain relief at all times including during dressing change
They are grossly under-dosed in clinical practice
I don't have too much of experience dealing with burn victims. But my thoughts on this topic would include

Anaesthetics do pose serious issues in burns patients. To name a few

Altered drug distribution – pharmacokinetics and pharmacodynamics
Prone for hypothermia
Electrolyte disturbance
Airway problem
Difficult IV access
Prone to infection & Septiciemia
Difficult to fix monitoring devices
Altered fluid distribution
Difficulty in transportation

All these probably lead the patient to undergo dressing changes in the ward itself.
Administering anaesthetics to these high risk patients in "out of theatre" situation may be extremely dangerous.
I think this  is the reason why burn patients do not get what they actually deserve.
I think all burn wards must have a minor OT attached to it, fully equipped with all anaesthetic devices and monitors for safe and effective care of patients.
As regard to pain relief techniques I think potent narcotics can be combined with O2 with sevoflurane may be good.
Supraglottic devices may be good options
Propofol- Ketamine combination may work
Newer sedatives like Dexmedetomidine may have a role



Just to add to your comments,
Burns patients have consumed lots of Analgesics and Sedatives, as they are in extreme pain.
Due to this their need of drugs is much higher than calculated doses. They keep coming out much faster and the procedures last very long if the areas are more and needs lot of cleaning and dressing.
But overall, high risk and expensive.