3 Burns management in children

The complete care of the thermally injured child requires the co-ordinated services of many medical and para-medical specialists. This has been referred to as the burns team, of which the anaesthetist is a vital member at all stages of treatment. The anaesthetist's skills in resuscitation, airway management, intravascular volume management, sedation and pain relief are required from the outset. The practice of early excision of the cutaneous lesion requires that the anaesthetist is familiar with the changing metabolic picture of the developing burns process. The effects of the injury and the surgical management demands modification to anaesthetic practice. The altered pharmacodynamics and pharmacokinetics are particularly relevant, as are the responses to the rapid haemodynamic and coagulation changes associated with major blood and fluid loss. If not directly responsible for the intensive care of the child, a complete knowledge of the pulmonary and cerebral changes associated with the unique injuries sustained in a house fire is essential for successful anaesthesia during surgical management.