Name of the Procedure:

Anesthesia for Second- and Third-Degree Burn Excision or Debridement with or without Skin Grafting

Common Name(s):

Anesthesia for burn surgery, burn debridement anesthesia

Technical/Medical Terms:

Excision, debridement, skin grafting, total body surface area (TBSA)

Summary

This procedure involves providing anesthesia to a patient undergoing surgical removal of damaged skin tissues from second- and third-degree burns. The surgery may also involve grafting new skin to the affected areas. The anesthesia is specific to surgeries where the burn treatment covers between 4% and 9% of the patient's total body surface area (TBSA).

Purpose

This procedure aims to manage pain and ensure the patient's comfort and safety during the excision or debridement of severe burns and potential skin grafting. The goal is to remove damaged skin, prevent infections, promote healing, and ultimately restore skin function and appearance.

Indications

• Second- or third-degree burns causing significant tissue damage
• Presence of necrotic (dead) tissue requiring removal
• High risk of infection if the damaged skin is not treated
• Poor healing that necessitates surgical intervention and skin grafting

Preparation

• Patient must fast (no food or drink) for at least 8 hours before the procedure.
• Adjustments in medication may be needed, particularly if the patient takes blood thinners or other medications that affect surgery.
• Preoperative assessments including blood tests, imaging studies, and a thorough physical examination.

Procedure Description

1. Preoperative Care:

   • The patient is brought to the operating room and connected to monitoring equipment.
   • An intravenous (IV) line is placed for medications and fluids.

2. Administration of Anesthesia:

   • The anesthesiologist administers general anesthesia to render the patient unconscious and free from pain.
   • Airway management is ensured, often through intubation.

3. Burn Excision/Debridement:

   • The surgeon removes the damaged skin and cleans the burn site.
   • In cases requiring skin grafting, healthy skin is harvested from another part of the body and grafted onto the affected areas.

4. Postoperative Care:

   • The patient is brought to the recovery room where anesthesia effects are monitored and managed.

   Duration

   The duration can vary but generally takes between 2 to 4 hours depending on the extent of burns and complexity of the procedure.

Setting

The procedure is performed in a hospital operating room equipped with advanced surgical and monitoring equipment.

Personnel

• Anesthesiologist
• Burn surgeon/plastic surgeon
• Surgical nurses
• Anesthesia technicians
• Operating room assistants

Risks and Complications

• Common Risks: Nausea, vomiting, sore throat (from intubation)
• Rare Risks: Allergic reactions to anesthesia, breathing difficulties, infections at the surgical site, blood loss
• Complications include prolonged unconsciousness, cardiorespiratory issues, and severe infections.

Benefits

• Effective pain control during surgery.
• Removal of damaged tissues to promote healing.
• Reduced risk of infection.
• Enhanced recovery and more successful outcomes from skin grafting.

Recovery

• Patients are monitored in the recovery room until they regain full consciousness.
• Pain management includes IV or oral medications.
• Wound care instructions are provided.
• Limited physical activity and follow-up appointments for wound assessment and further treatments if necessary.
• Recovery can vary; initial healing takes a few weeks, but full recovery might take months depending on the extent of burns.

Alternatives

• Advanced wound care techniques without surgery (limited to less severe burns).
• Topical and systemic antibiotics for infection control.
• Non-surgical debridement methods, such as enzymatic debridement.

Patient Experience

• Patients will be unconscious during the procedure and will not feel any pain.
• Postoperative pain is managed with medications.
• Initial discomfort from surgical wounds is expected, but pain tends to diminish as healing progresses.
• Follow-up care including dressing changes, physical therapy, and possibly additional surgeries or treatments for optimal recovery.