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Abstract
Management of the pediatric burn patient presents a variety of clinical challenges for the pediatric anesthesiologist. Despite the high incidence of burn injuries, standard management strategies are far from universal. The complex physiologic changes presented by burn injuries present airway management and resuscitation challenges and mandate careful consideration of adequate nutritional support. Long hospital stays with frequent operations and dressing changes necessitate creative approaches to anxiolysis and pain control. Underutilized modalities warranting further research include regional anesthesia and nonpharmacologic approaches, such as virtual reality. Further research and collaboration between burn centers are needed to standardize care for this population.
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Weis HB, Meinhardt KE, Minhajuddin A, Viroslav H, Colletti M, Weis JJ, Taveras LR, Madni TD, Imran JB, Clark AT, Pickett ML, Phelan HA, Ambardekar AP. Administration of Tumescence in Pediatric Burn Patients Causes Significant Hypertension. J Burn Care Res 2019; 40:752-756. [DOI: 10.1093/jbcr/irz081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AbstractThe effects of injecting tumescence containing phenylephrine in pediatric burn patients are unknown, but anecdotally our clinicians note a high incidence of hypertension requiring treatment. This study sought to determine whether tumescence with phenylephrine was associated with hypertension requiring treatment in our pediatric burn patients. This was a retrospective cohort study of pediatric burn patients who underwent tangential excision with split-thickness autografting, excision alone, or autografting alone from 2013 to 2017. Records were reviewed for hypertensive episodes, defined as ≥2 consecutive blood pressure readings that were >2 SD above normal. Published intraoperative age- and sex-adjusted standards were used to define reference values. Parametric and nonparametric tests were used when appropriate. In total, 258 operations were evaluated. Mean patient age was 7.6 ± 5.2 years, and 64.7% were male. Patients were predominately white (69.8%). Overall, there was a 62.8% incidence of hypertension. On univariate logistic regression analysis, duration of operation, estimated blood loss, treated TBSA, and weight-adjusted volume of tumescence were significant predictors of intraoperative hypertension (P < .01). On multivariate analysis, weight-adjusted volume of tumescence alone was significantly associated with the presence of hypertension with an odds ratio of 2.0 (95% confidence interval: 1.33–3.04). Of the 162 operations which exhibited at least one episode of significant hypertension, 128 cases (79%) were treated. Intraoperative administration of phenylephrine-containing tumescence in pediatric burn patients is associated with clinically significant hypertension requiring treatment. This practice should be conducted with caution in pediatric burn operations until its clinical implications are defined.
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Affiliation(s)
- Holly B Weis
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas
| | - Kyle E Meinhardt
- Department of Anesthesiology, University of Texas Southwestern Medical Center, Dallas
| | - Abu Minhajuddin
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas
| | - Hannah Viroslav
- University of Texas Southwestern Medical School, University of Texas Southwestern Medical Center, Dallas
| | - Meaghan Colletti
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas
| | - Joshua J Weis
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas
| | - Luis R Taveras
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas
| | - Tarik D Madni
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas
| | - Jonathan B Imran
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas
| | - Audra T Clark
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas
| | - Maryanne L Pickett
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas
| | - Herb A Phelan
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas
| | - Aditee P Ambardekar
- Department of Anesthesiology, University of Texas Southwestern Medical Center, Dallas
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3
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Li E, Distefano A, Sohrab M. Periorbital oedema secondary to emactuzumab treated with topical 2.5% phenylephrine. Clin Exp Ophthalmol 2019; 47:800-801. [DOI: 10.1111/ceo.13498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 02/17/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Emily Li
- Department of Ophthalmology and Visual ScienceYale University School of Medicine New Haven Connecticut
| | - Alberto Distefano
- Department of OphthalmologyBoston University School of Medicine Boston Massachusetts
| | - Mahsa Sohrab
- Department of Ophthalmology and Visual ScienceYale University School of Medicine New Haven Connecticut
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Ho CWG, Kok YO, Chong SJ. Photographic evaluation of different adrenaline-containing tumescent solutions on skin graft donor site bleeding: A prospective randomised trial. Burns 2018; 44:2018-2025. [DOI: 10.1016/j.burns.2018.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 02/18/2018] [Accepted: 03/09/2018] [Indexed: 12/30/2022]
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Stone Ii R, Natesan S, Kowalczewski CJ, Mangum LH, Clay NE, Clohessy RM, Carlsson AH, Tassin DH, Chan RK, Rizzo JA, Christy RJ. Advancements in Regenerative Strategies Through the Continuum of Burn Care. Front Pharmacol 2018; 9:672. [PMID: 30038569 PMCID: PMC6046385 DOI: 10.3389/fphar.2018.00672] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 06/05/2018] [Indexed: 01/09/2023] Open
Abstract
Burns are caused by several mechanisms including flame, scald, chemical, electrical, and ionizing and non-ionizing radiation. Approximately half a million burn cases are registered annually, of which 40 thousand patients are hospitalized and receive definitive treatment. Burn care is very resource intensive as the treatment regimens and length of hospitalization are substantial. Burn wounds are classified based on depth as superficial (first degree), partial-thickness (second degree), or full-thickness (third degree), which determines the treatment necessary for successful healing. The goal of burn wound care is to fully restore the barrier function of the tissue as quickly as possible while minimizing infection, scarring, and contracture. The aim of this review is to highlight how tissue engineering and regenerative medicine strategies are being used to address the unique challenges of burn wound healing and define the current gaps in care for both partial- and full-thickness burn injuries. This review will present the current standard of care (SOC) and provide information on various treatment options that have been tested pre-clinically or are currently in clinical trials. Due to the complexity of burn wound healing compared to other skin injuries, burn specific treatment regimens must be developed. Recently, tissue engineering and regenerative medicine strategies have been developed to improve skin regeneration that can restore normal skin physiology and limit adverse outcomes, such as infection, delayed re-epithelialization, and scarring. Our emphasis will be centered on how current clinical and pre-clinical research of pharmacological agents, biomaterials, and cellular-based therapies can be applied throughout the continuum of burn care by targeting the stages of wound healing: hemostasis, inflammation, cell proliferation, and matrix remodeling.
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Affiliation(s)
- Randolph Stone Ii
- Combat Trauma and Burn Injury Research, US Army Institute of Surgical Research San Antonio, TX, United States
| | - Shanmugasundaram Natesan
- Combat Trauma and Burn Injury Research, US Army Institute of Surgical Research San Antonio, TX, United States
| | - Christine J Kowalczewski
- Combat Trauma and Burn Injury Research, US Army Institute of Surgical Research San Antonio, TX, United States
| | - Lauren H Mangum
- Combat Trauma and Burn Injury Research, US Army Institute of Surgical Research San Antonio, TX, United States.,Extremity Trauma and Regenerative Medicine, US Army Institute of Surgical Research San Antonio, TX, United States
| | - Nicholas E Clay
- Combat Trauma and Burn Injury Research, US Army Institute of Surgical Research San Antonio, TX, United States
| | - Ryan M Clohessy
- Combat Trauma and Burn Injury Research, US Army Institute of Surgical Research San Antonio, TX, United States
| | - Anders H Carlsson
- Dental and Craniofacial Trauma Research, US Army Institute of Surgical Research San Antonio, TX, United States
| | - David H Tassin
- Dental and Craniofacial Trauma Research, US Army Institute of Surgical Research San Antonio, TX, United States
| | - Rodney K Chan
- Dental and Craniofacial Trauma Research, US Army Institute of Surgical Research San Antonio, TX, United States
| | - Julie A Rizzo
- Burn Flight Team, US Army Institute of Surgical Research San Antonio, TX, United States
| | - Robert J Christy
- Combat Trauma and Burn Injury Research, US Army Institute of Surgical Research San Antonio, TX, United States
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Herlihy CR, Barry C. Anesthesia and Burns. Anesthesiology 2018. [DOI: 10.1007/978-3-319-74766-8_78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Rojas S, Pérez del Caz MD, Esteban Vico JR, Villaverde E, Llinas A, Martínez JR, Brage C, Valero J, González Rodríguez A, Garcia Barreiro J, López-Suso E, Fernandez-Cañamaque JL, López R, Murat J. EHTIC study: Evaluation of a new hemostatic agent based on tissue factor in skin grafting procedures. Burns 2017; 43:780-788. [DOI: 10.1016/j.burns.2017.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 11/21/2016] [Accepted: 01/05/2017] [Indexed: 10/20/2022]
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Abstract
Care of burn-injured patients requires knowledge of the pathophysiologic changes affecting virtually all organs from the onset of injury until wounds are healed. Massive airway and/or lung edema can occur rapidly and unpredictably after burn and/or inhalation injury. Hemodynamics in the early phase of severe burn injury is characterized by a reduction in cardiac output and increased systemic and pulmonary vascular resistance. Approximately 2 to 5 days after major burn injury, a hyperdynamic and hypermetabolic state develops. Electrical burns result in morbidity much higher than expected based on burn size alone. Formulae for fluid resuscitation should serve only as guideline; fluids should be titrated to physiologic endpoints. Burn injury is associated basal and procedural pain requiring higher than normal opioid and sedative doses. Operating room concerns for the burn-injured patient include airway abnormalities, impaired lung function, vascular access, deceptively large and rapid blood loss, hypothermia, and altered pharmacology.
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Affiliation(s)
- Edward A Bittner
- From the Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (E.A.B., E.S., J.A.J.M.); Shriners Hospitals for Children®, Boston, Massachusetts (E.A.B., E.S., J.A.J.M.); Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas (L.W.); and Shriners Hospitals for Children®, Galveston, Texas (L.W.)
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Sogut O, Erdogan MO, Kose R, Boleken ME, Kaya H, Gokdemir MT, Ozgonul A, Iynen I, Albayrak L, Dokuzoglu MA. Hemostatic Efficacy of a Traditional Medicinal Plant Extract (Ankaferd Blood Stopper) in Bleeding Control. Clin Appl Thromb Hemost 2013; 21:348-53. [DOI: 10.1177/1076029613504129] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The aim of this study is to assess the in vivo hemostatic effect of Ankaferd Blood Stopper (ABS) on rats using a tail bleeding model. Wistar rats were randomized into 4 groups of 9 each: group 1, control, no pretreatment, irrigated with saline; group 2, no pretreatment, irrigated with ABS; group 3, control, heparin pretreatment, irrigated with saline; and group 4, heparin pretreatment, irrigated with ABS. To control bleeding, compressive dressings were placed after instilling 1 mL of either ABS or saline to the bleeding area. Without heparin pretreatment, ABS shortened hemostasis time by 1.57 minutes and reduced the amount of bleeding by 0.85 g. With heparin pretreatment, ABS shortened hemostasis time by 3.29 minutes and reduced the amount of bleeding by 1.32 g. The ABS was more effective than saline irrigation for treating tail tip bleeding in rats, with or without heparin pretreatment, while also using a compressive dressing.
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Affiliation(s)
- Ozgur Sogut
- Faculty of Medicine, Department of Emergency Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Mehmet Ozgur Erdogan
- Department of Emergency Medicine, Haydarpasa Numune Research and Training Hospital, Istanbul, Turkey
| | - Rustu Kose
- Faculty of Medicine, Department of Plastic and Reconstructive Surgery, Recep Tayyip Erdogan University, Rize, Turkey
| | - Mehmet Emin Boleken
- Faculty of Medicine, Department of Paediatric Surgery, Harran University, Sanliurfa, Turkey
| | - Halil Kaya
- Faculty of Medicine, Department of Emergency Medicine, Harran University, Sanliurfa, Turkey
| | - Mehmet Tahir Gokdemir
- Faculty of Medicine, Department of Emergency Medicine, Harran University, Sanliurfa, Turkey
| | - Abdullah Ozgonul
- Faculty of Medicine, Department of General Surgery, Harran University, Sanliurfa, Turkey
| | - Ismail Iynen
- Faculty of Medicine, Department of Otolaryngology-Head and Neck Surgery, Harran University, Sanliurfa, Turkey
| | - Levent Albayrak
- Faculty of Medicine, Department of Emergency Medicine, Harran University, Sanliurfa, Turkey
| | - Mehmet Akif Dokuzoglu
- Faculty of Medicine, Department of Emergency Medicine, Harran University, Sanliurfa, Turkey
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Abstract
For 2011, approximately 1746 original research articles in burns were published in English in scientific journals. This article reviews those with the most potential impact on for burn therapeutics and outcomes according to the Editor of one of the major journals (Burns) and his colleague. As done previously, articles were found and divided into these topic areas: epidemiology of injury and burn prevention, wound and scar characterisation, acute care and critical care, inhalation injury, infection, psychological considerations, pain and itching management, rehabilitation and long-term outcomes, and burn reconstruction. Each selected article is mentioned briefly with editorial comment.
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Affiliation(s)
- Steven E Wolf
- Division of Burn, Trauma, and Critical Care, Department of Surgery, University of Texas - Southwestern Medical Center, United States.
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Kose R, Sogut O, Demir T, Koruk I. Hemostatic Efficacy of Folkloric Medicinal Plant Extract in a Rat Skin Bleeding Model. Dermatol Surg 2012; 38:760-6. [DOI: 10.1111/j.1524-4725.2011.02288.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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