Anesthetic management of patients with major burn injury

Burn injury is a leading cause of life-threatening trauma worldwide, affecting more than 450,000 Americans each year, and is associated with an average mortality rate of 0.8%. Patients with an increased risk of death from burn injuries include elderly patients and patients with large burns or inhalation injury. Providing optimal care for patients with major burn injuries requires the coordinated effort of multidisciplinary teams in which anesthesia providers play a critical role. Anesthetic management for burn surgery can be technically challenging because of difficult airway management and vascular access, as well as cognitively demanding because of dramatic pathophysiologic changes that compromise hemodynamic stability and alter patient response to many anesthetic agents. The following article reviews the literature related to the pathophysiology and clinical management of major burn injuries and highlights the key concepts relevant to the delivery of safe and efficacious anesthesia for these patients.