Objectives

1. Understand the pathophysiology of a burn patient, including airway, respiratory, cardiac, hematologic, liver, and gastrointestinal functions, nutrition, metabolism, electrolyte abnormalities, thermoregulation, immune suppression, and renal function.

2. Understand the preoperative requirements for surgery, including a thorough history and physical, proper laboratory tests, appropriate intravenous access, and preoperative medications.

3. Understand the surgical process of wound care, excision and grafting, and alternative skin care.

4. To safely administer intraoperative anesthetic management, including proper monitor selection, thermal regulation, ventilation, maintenance anesthesia, and calculation of the estimated blood loss during the excision.

5. To give appropriate postoperative care, including the management of the airway and chronic pain control.

INTRODUCTION

Burn injury is regarded as one the most costly and challenging of all trauma care [1]. The skin is the largest organ of the human body, and it plays a very important role in physiology and the maintenance of body homeostasis. A large burn can alter the ability of almost all of the body's organs and significantly increase the patient's risk for infection [2]. It is estimated that about 1 million burn injuries are treated per year, with about 50,000 requiring hospitalization, and about 6,000 related deaths [1, 3, 4]. About one third of all burn admissions to the hospital are children under age 15 years, and about 2,000 of the burn-related deaths annually are in children [2]. Mortality is high with burn injuries, but in recent years there has been a significant improvement in survival secondary to the development of multidisciplinary burn teams, early and aggressive surgical treatments, advances in critical care, and improved understanding of burn pathophysiology [3, 4].