Total Intravenous Anesthesia for Major Burn Surgery
ARMY INST OF SURGICAL RESEARCH FORT SAM HOUSTON TX
Pagination or Media Count:
Abstract Total intravenous anesthesia TIVA is frequently used for major operations requiring general anesthesia in critically ill burn patients. We reviewed our experience with this approach. Methods During a 22-month period, 547 major burn surgeries were performed in this center s operating room and were staffed by full-time burn anesthesiologists. The records of all 123 TIVA cases were reviewed 112 records were complete and were included. For comparison, 75 cases were selected at random from a total of 414 non-TIVA general anesthetics. Some patients had more than one operation during the study as appropriate for the analysis in question, each operation or each patient was entered as an individual case. For inter-patient analysis, exposure to 1 or more TIVAs was used to categorize a patient as member of the TIVA group. Results Excision and grafting comprised 78.2 of the operations. 14 TIVA regimens were used, employing combinations of 4 i.v. drugs ketamine K, 91 cases i.v. methadone M, 62 fentanyl F, 58 and propofol P, 21. The most common regimens were KM 34 cases KF 26 KMF 16 and K alone 8. Doses used often exceeded those used in non-burn patients. TIVA was preferred for those patients who were more critically ill prior to surgery, with a higher ASA score 3.87 vs. 3.11. Consistent with this, inhalation injury 26.7 vs. 1.6, burn size TBSA, 36.3 vs. 15.8, and full-thickness burn size FULL, 19.8 vs. 6.5 were higher in TIVA than in non-TIVA patients. Despite this, intraoperative pressor use was as common in TIVA as in non-TIVA cases 23.9 vs. 22.7. Conclusions TIVA was used in patients whose inhalation injury rate and TBSA were greater than those of non-TIVA patients. TIVA cases were not associated with increased hemodynamic instability. TIVA is a viable approach to general anesthesia in critically ill burn patients.
- Medicine and Medical Research