| Clinical Experience of Ketamine for Burned Patients . |
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Wha Sung Chung, Hung Kun Oh |
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Department of Anesthesiology, Yonsei University College of Medicine, Seoul, Korea. |
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| Abstract |
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The severely burned patient, when first seen by the anesthesiologist, is usually in the "high-risk" category, envincing malnutrition and protein defficiency, combined with toxicity, dehydration and oliguria. Since homeostatic controls are markedly impaired, the cardiovascular system may be unable to respond to the changes in body position frequently necessary during surgical procedures. Especially when the burn involves the head, neck, and upper chest, the mucous membrane of the respiratory tract may be edematous and pulmonary atelectasis may be present. Inhalation agents such as ether, halothane, methoxyflurane, cyclopropane and nitrous oxide have serious disadvantages in anesthesia for burned patients, because: 1) the use of endotracheal tube to ensure an unobstructed airway is mandatory, but use of succinyl-choline for intubation may be dangerous, 2) there is a danger of introducing pathogenic organisms into upper respiratory tract with repeated intubation. 3) inhalation agents may impair the function of liver, kidney, and hemopoietic system. In the course of our clinical experience of ketamine in 45 burned patients, it became apparent that ketamine may be the anesthetic of choice for burn surgery, particularly for children, since the drug offers several distinct advantages over conventionally employed anesthetic agents. Protective reflexes are peserved, thereby rendering unnecessary an endotracheal tube. Also cardiovascular homeostasis, ease and simplicity of administration, rapid onset of anesthetic action, short duration, relatively quick recovery, virtual absence of postanesthetic nausea and vomiting and of toxicity for vital organs, and the absence of clinically detectable respiratory depression seemed to provide optimal conditions for surgery in burns. |
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