A lesson from Beyond the Burn: Navigating Modern Burn Care

Pharmaceutical Interventions for Burn Victims

In the intraoperative setting, caution must be exercised regarding the administration of muscle relaxants in burn patients. Succinylcholine should be avoided after the initial 24 hours post-injury due to the risk of an exaggerated hyperkalemic response (Martyn 2006). Burn patients may also exhibit reduced sensitivity to the neuromuscular effects of nondepolarizing muscle relaxants (NDMRs), necessitating higher dosages to achieve desired paralysis (Bittner 2016). Similarly, drugs like rocuronium and atracurium may require increased dosing to maintain efficacy in burned patients (Bittner 2016). The selection of anesthetic agents should be guided by considerations such as hemodynamics, pulmonary function, and the anticipated difficulty of airway management. While the choice of volatile anesthetics is not expected to significantly alter outcomes in burned patients, special attention is required if propofol is used for induction or sedation. It should be noted that propofol clearance and volume of distribution may be substantially elevated in patients with major burn injuries (Bittner 2016). Therefore, intraoperative administration of propofol may necessitate larger bolus doses or increased infusion rates to achieve the desired effect (Bittner 2016).

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