[Anesthesia for severely burned patients--23 operations in 8 burned patients]

Severely burned patients require repeated debridement or skin grafting soon after the burn injury until the closure of the injury. We retrospectively examined 23 operations in 8 severely burned patients who had undergone debridement or skin grafting more than twice within 30 days. We classified 23 operations into 1st to 4th categories according to days after the burn injury and compared each group regarding intraoperative fluid balance, hypovolemia and perioperative complications. In the 3rd or 4th operation, mean blood loss and fluid administration were more than those of the 1st or 2nd operation. Respiratory dysfunctions or circulatory complications such as hypotension, oliguria occurred more frequently during or after the 3rd or 4th operation. Since patients are in hyperdynamic and hypercatabolic state at the time of the 3rd or 4th operation patients, they will be easily damaged in the peri-operative period. This study suggests that we should bear in mind, in the anesthetic management of burned patients, that they can be in hyperdynamic state as well as in shock state.