Little words BIG impact: Perioperative communication for children with burns

Anaesthetists are key members of teams caring for burn-injured children in almost every aspect of their management. Their role can involve initial resuscitation, intensive care, analgesia, and anaesthesia for multiple procedures both acutely and subsequently for scar management. As key members of burns management teams, effective communication with patients and their families as well as other members of the burn care team is vital. There is little guidance, however, addressing how the anaesthetist might communicate and optimise anaesthetic burns care of children pre-, intra-, and postoperatively. Advances in the understanding of the neurobiology of communication suggests that we need to consider positive (placebo) or negative (nocebo) subconscious processes. Learnable language structures GREAT (Greeting, Rapport, Expectations, Addressing concerns, Tacit agreement) and LAURS (Listening, Acceptance, Utilisation, Reframing, Suggestion) can facilitate any patient or family interaction ensuring children and their parents feel they are being heard and understood. Talking about finishing rather than starting when about to perform a potentially painful procedure can also facilitate burns care with children. Other strategies include the avoidance of nocebo communications or apologising before a painful procedure and, instead, focusing on therapeutic (placebo) alternatives. Children do not view pain in the same way as adults do, and techniques such as play therapy and hypnosis can be valuable adjuncts to traditional analgesia administration in burns care, with the added benefit of minimising side-effects. The use of regular time-outs during prolonged burns surgeries is a helpful communication strategy between the anaesthetist and other members of the burns team that can optimise patient safety. Communication is a core clinical skill in the practice of anaesthesia during paediatric burns care and is an area for future research.

The enhancing effects of a chicken-meat extract on serum Ig concentrations in normal and scalded animals

The aim of the study was to investigate the effects of a chicken-meat extract known as Essence of Chicken (EOC) on immune function in a normal and scalded animal model. In this experimental study, 120 rats were randomly allocated into three groups: a SHAM group (inflicted with a sham wound), a BURN group (inflicted with a full-thickness scald wound covering 30 % of total body surface area) and a CONTROL group. Rats in the SHAM and BURN groups were further divided into normal saline (NS)-fed and EOC-fed groups. They were fed by force-feeding with a feeding needle and blood samples were taken from each group on days 1, 8, 15 and 22 postburn. Serum IgG, IgA and IgM concentrations were determined by ELISA and the results of the EOC-fed and NS-fed cohorts of both the SHAM and BURN groups were compared. The level of significance was set atP<0·05. Serum IgG level of both SHAM-EOC and BURN-EOC cohorts showed significant elevation on day 8. IgA exhibited a significant increase in the SHAM-EOC group on day 15 and in the BURN-EOC group on day 22. A significant increase of IgM level was found on days 1 and 22 for the SHAM-EOC group and on day 15 for the BURN-EOC group. Conclusively, EOC was shown to have an enhancing effect on serum Ig levels for both normal and tissue-stressed rats. It is suggested that EOC may help improve immune function when the immune system is at normal status or when it faces a challenge.