Why isn't anesthesia used during burn wound debridement?

[Green Xenon]

Hi:

 

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?

 

 

Thanks,

 

Green Xenon

[CharonY]

Why would you think that no anesthesia is used on burn patients? I believe that wound patients are challenging for the anesthesiologist due to the unstable nature of the patient. In some rare cases it may not be advisable, but I believe that it is pretty much common practice.

[John Cuthber]

There is a potential problem with local anaesthetics- they get absorbed through the large open wounds and they are rather toxic if you get a lot of them.

[Rickdog]

Both replies are correct, the possible toxic effect of the anaesthesia you decide to use, can get exacerbated due to the instability of the pacient, so if its decided to use them, it must only be done by an expert in the use of anaesthetics. The changes in stability, related to hemodynamics and cardio-vascular condition are very present in a burned pacient, so you have to be very well prepared to know how to act in any case, usually a general phisician doesn`t have the expertice required for such cases in relation to the maintanance of the sedation. Also there are other facts in relation to the patience that can increase the risk to him by the use of anaesthesia. In burned patients it is very likely, for instance that his respiratory pathways can be ocluded or with rests of burned material or with rests of smoke and/or dry pieces of epithelial tissue in the respiratory tracts, that will affect the response of the patience, and of course kill him, in the long term. Also many anaesthetics have an inmune deppression effect, so the risk of infection in these patients is increased, which is already increased, before the application of anaesthesia, due to the extensive loss of skin in them.

[lucky45]

on 3rd degree burns, Nerves are destroyed and pain meds are not needed