Canadian Journal of Anesthesia, Vol 10, 501-507, Copyright © 1963 by Canadian Anesthesiologists' Society

Burn Mortality and the Anaesthetist

The anaesthetist must be prepared to play his part in attempting to reduce the hard core of mortality from burns which remains. Early skin grafting is important even in the presence of marked pulmonary infection. Colonization of large wounds left ungrafted is often followed by fatal septicaemia. The deterioration from this condition is often sudden and rapid. Septicaemia due to Pseudomonas aeruginosa is increasing in incidence and only the use of a specific anti-serum seems to offer any hope against it at the moment.

Pathology is widespread and complex. We should encourage careful planning of autopsies and focus special attention on the respiratory tract.

Failure of both adrenal medulla and cortex has been described. The use of hydrocortisone may be necessary with third-degree burns covering more than 40 per cent of the body surface area.

Succinylcholine should not be used in the burned patient, certainly not in the extensive and long-standing case. The mechanism of cardiac arrest due to this drug has not been satisfactorily explained.

Recent reports on the possible hepatotoxicity of halothane preclude its use in bad burns; it seems no wiser to use methoxyflurane either at the moment.