Introduction

The burned patient, when considered for an anaesthetic assessment, must be regarded as suffering from a most severe form of trauma and all the principles of assessment, resuscitation and treatment associated with multiple trauma must be followed. There may be other injuries sustained at the time of the burn, including inhalation, which will have to be dealt with during the resuscitation period. The benefits of anaesthesia and surgery must always outweigh the risks when all relevant information is taken into account.

There are three periods during which the burned patient may undergo anaesthesia for a surgical procedure. These are:

1. Immediate – From the time of the injury until cardiovascular stability has been established

2. Early – After resuscitation, 2–7 days post-burn

3. Late – More than 2 weeks post-burn.

There are major similarities between all three periods but each has different facets which may affect the type of anaesthesia chosen for the varied procedures that need to be carried out.

The immediate period

This period may last up to 48 hours from the time of the burn. There are two indications for operating at this time and they are at either end of the severity spectrum. If a major burn has been sustained, anaesthesia must only be contemplated if other trauma has caused a life-threatening situation which can only be remedied by surgery. If possible, resuscitation and stabilization must be completed prior to surgery. The second reason for operating would be to debride a small wound in a fit, healthy patient with minimal physiological disturbance. First, the major burn and associated trauma or life-threatening problems.