Anesthetic management of an obstetric patient with major burn injury for emergent C-section

We present the case of a pregnant 34 year old female, 38 weeks gestational age, who presented for an emergent C-section in the setting of 65% full thickness burn injury and fetal distress. Anesthetic management of a patient... [ view full abstract ]

We present the case of a pregnant 34 year old female, 38 weeks gestational age, who presented for an emergent C-section in the setting of 65% full thickness burn injury and fetal distress. Anesthetic management of a patient with full skin thickness burn wounds poses several challenges to the anesthesiologist. Airway management, temperature control, coagulation status and hemodynamic management are of paramount importance. Fluid resuscitation for major burn patients often takes place intraoperatively due to the urgency for surgical intervention, bypassing resuscitation in the emergency room or intensive care unit. Obstetric trauma patients also present challenges. Uteroplacental blood flow is pressure dependent without autoregulation, highlighting importance of intraoperative resuscitation in this case; many anesthetic medications administered to the obstetric patient cross into placental circulation and may affect fetal well-being, especially in the setting of fetal distress. This case demonstrates several uncommon circumstances which led to a challenging intraoperative and postoperative course. Careful resuscitation and medication choice as well as efficient team coordination were key in ensuring this patient's safety during the case.