Summary
The anaesthetist must be prepared to play his part in attempting to reduce the hard core of mortality from burns which remains. Early skin grafting is important even in the presence of marked pulmonary infection. Colonization of large wounds left ungrafted is often followed by fatal septicaemia. The deterioration from this condition is often sudden and rapid. Septicaemia due toPseudomonas aeruginosa is increasing in incidence and only the use of a specific anti-serum seems to offer any hope against it at the moment.
Pathology is widespread and complex. We should encourage careful planning of autopsies and focus special attention on the respiratory tract.
Failure of both adrenal medulla and cortex has been described. The use of hydrocortisone may be necessary with third-degree burns covering more than 40 per cent of the body surface area.
Succinylcholine should not be used in the burned patient, certainly not in the extensive and long-standing case. The mechanism of cardiac arrest due to this drug has not been satisfactorily explained.
Recent reports on the possible hepatotoxicity of halothane preclude its use in bad burns; it seems no wiser to use methoxyflurane either at the moment.
Résumé
ľanesthésiste doit se préparer à jouer un rôle pour essayer de réduire le taux très élevé de mortalité qui subsíste chez les brûlés. Il est de première importance de faire des greffes cutanées aussitôt que possible, même s’il existe une infection respiratoire. Une contamination de plaies étendues non greffées entraîne souvent une septicémie fatale. Dans ces cas, le malade dépérit soudainement et rapidement. La fréquence des septicémies aux pseudomonas aeruginosa augmente et, actuellement, le seul espoir que nous ayons pour juguler cette infection est ľusage ďun antisérum.
La pathologie se généralise de façon complexe. Il faudrait tenter ďobtenir des autopsies soignées et orienter la recherche particulièrement sur le système respiratoire.
Certains ont décrit une dégénérescence simultanée de la corticale et de la médullaire surrénaliennes. Chez les brûlés du troisième degré dont la surface des lésions atteint 40 pour cent de la surface corporelle, il peut être nécessaire de recourir è ľusage de ľhydrocortisone.
Il faut s’abstenir ďutiliser la succinylcholine chez les brûlés particulièrement s’il s’agit ďun grand brûlé et si ľanesthésie doit se prolonger. La faÇon dont la succinylcholine entraîne un arrêt cardiaque ne s’explique pas de faÇon satisfaisante.
Récemment, on a cité des cas de séquelles hépatiques à la suite ďanesthésies au fluothane; en conséquence, chez des brûlés, il serait déconseillé ďutiliser cet agent; il serait également plus sage de ne pas employer le méthoxyflurane.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Phillips A. W. &Cope, O. An Analysis of the Effect of Burn Therapy on Burn Mortality. Research in Burns, p. 1. The Proceedings of the First International Congress on Research in Burns. Washington: American Institute of Biological Sciences and Philadelphia: F. A. Davis Company (1962).
Wartman, W. B. Mechanism of Death in Severe Burn Injury: The Need for Planned Autopsies. Research in Burns, p. 6 (1962).
Schlegel, J. V. &Gabor, F. Experimental Burns. Surgical Forum, Vol. 10, p. 346. Chicago, Ill.: American College of Surgeons (1960).
Management of the Coconut Grove Burns at the Massachussetts General Hospital. Ann. Surg.117: 801–965 (1943).
Watson D. E.; Schloerb, P. R.; & Darrow, D. C. Carbon Dioxide Loss from Burned Skin. Surgical Forum, Vol. 10, p. 355. Chicago, III.: American College of Surgeons.
McCaughey, T. J. Hazards of Anaesthesia for the Burned Child. Canad. Anaesth. Soc. J.9: 220 (1962).
Jackson, D. MacG. The Treatment of Burns: An Exercise in Emergency Surgery. Ann. Rov. Coll. Surgeons of Engl.13: 236 (1953).
Unger, A. &Haynes, B. W. Jr. Hemodynamic Studies in Severely Burned Patients. Surgical Forum Vol. 10, p. 356. Chicago, Ill.: American College of Surgeons (1960).
Tumbusch, W. T.; Vogel, E. H. Jr.; Butkiewicz, J. V.; Graber, C. D.; Larson, D. L.; & Mitchell, G. T. Jr. The Rising Incidence of Pseudomonas Septicemia Following Burn Iniury. Research in Burns, p. 235 (1962).
Millican, R. C. Role of Infection in the Delayed Deaths of Mice Following Extensive
Delarue, J.;Chomette, G.;Pinaudeau, Y.;Abelanet, R.; &Monsaigeon, A. Les lésions viscèrales des grands brûlés. Etude anatomo-pathologique de 50 cas de brûlures mortelles. Ann. anat. pathol.7(1): 53 (1962)
Goodall, McC. &Haynes, B. W. Jr. Adrenal Medullary Insufficiency in Thermal Burns. Surgical Forum, Vol. 10, p. 351. Chicago, Ill.: American College of Surgeons (1960).
Goodall, McC. Adrenaline and Noradrenaline in Thermal Burn. Reselarch in Burns, p.149(1962).
Feller, I. A Second Look at Adrenal Cortical Function in Burn Stress. Research in Burns, p. 163 (1962).
Bush, G. H.;Graham, H. A. P.;Littlewood, A. H. M.; &Scott, L. B. Dangers of Suxamethonium and Endotracheal Intubation in Anaesthesia for Burns. Brit. Med. J.2: 1081 (1962).
Pooler, H. E. Anaesthesia for Burns. Brit. Med. J.2: 1687 (1962).
Brody, G. L. &Sweet, R. B. Halothane Anesthesia as a Possible Cause of Massive Hepatic Necrosis. Anesthesiology24(1): 29 (1963).
Lindenbaum, J. &Leifer, E. Hepatic Necrosis Associated with Halothane Anesthesia. New Engl. J. Med.268(10): 525 (1963).
Bunker, J. P. &Blumenfeld, C. M. Liver Necrosis after Halothane Anesthesia: Cause or Coincidence? New Engl. J. Med.268(10): 531 (1963).
Rights and permissions
About this article
Cite this article
McCaughey, T.J. Burn mortality and the anaesthetist. Can. Anaes. Soc. J. 10, 501–507 (1963). https://doi.org/10.1007/BF03002077
Issue Date:
DOI: https://doi.org/10.1007/BF03002077