Int J Burn Trauma 2013;3(2):108-114
Original Article
Total intravenous anesthesia for major burn surgery
Leopoldo C Cancio, Phillip B Cuenca, Stephen C Walker, John M Shepherd
U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
Received December 1, 2012; Accepted January 29, 2013; Epub April 18, 2013; Published April 30, 2013
Abstract: Total intravenous anesthesia (TIVA) is frequently used for major operations requiring general anesthesia in critically
ill burn patients. We reviewed our experience with this approach. Methods: During a 22-month period, 547 major burn
surgeries were performed in this center’s operating room and were staffed by full-time burn anesthesiologists. The records of
all 123 TIVA cases were reviewed; 112 records were complete and were included. For comparison, 75 cases were selected at
random from a total of 414 non-TIVA general anesthetics. Some patients had more than one operation during the study: as
appropriate for the analysis in question, each operation or each patient was entered as an individual case. For inter-patient
analysis, exposure to 1 or more TIVAs was used to categorize a patient as member of the TIVA group. Results: Excision and
grafting comprised 78.2% of the operations. 14 TIVA regimens were used, employing combinations of 4 i.v. drugs: ketamine
(K, 91 cases); i.v. methadone (M, 62); fentanyl (F, 58); and propofol (P, 21). The most common regimens were KM (34 cases);
KF (26); KMF (16); and K alone (8). Doses used often exceeded those used in non-burn patients. TIVA was preferred for those
patients who were more critically ill prior to surgery, with a higher ASA score (3.87 vs. 3.11). Consistent with this, inhalation
injury (26.7 vs. 1.6%), burn size (TBSA, 36.3 vs. 15.8%), and full-thickness burn size (FULL, 19.8 vs. 6.5%) were higher in TIVA
than in non-TIVA patients. Despite this, intraoperative pressor use was as common in TIVA as in non-TIVA cases (23.9 vs.
22.7%). Conclusions: TIVA was used in patients whose inhalation injury rate and TBSA were greater than those of non-TIVA
patients. TIVA cases were not associated with increased hemodynamic instability. TIVA is a viable approach to general
anesthesia in critically ill burn patients. (IJBT1212001).
Keywords: Total intravenous anesthesia (TIVA), burn, surgery
Address correspondence to: Dr. Leopoldo C Cancio, U.S. Army Institute of Surgical Research, 3400 Rawley E. Chambers
Avenue, Fort Sam Houston, TX, 78234, USA. Phone: 210-916-3301; E-mail: lee.cancio@us.army.mil
Original Article
Total intravenous anesthesia for major burn surgery
Leopoldo C Cancio, Phillip B Cuenca, Stephen C Walker, John M Shepherd
U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
Received December 1, 2012; Accepted January 29, 2013; Epub April 18, 2013; Published April 30, 2013
Abstract: Total intravenous anesthesia (TIVA) is frequently used for major operations requiring general anesthesia in critically
ill burn patients. We reviewed our experience with this approach. Methods: During a 22-month period, 547 major burn
surgeries were performed in this center’s operating room and were staffed by full-time burn anesthesiologists. The records of
all 123 TIVA cases were reviewed; 112 records were complete and were included. For comparison, 75 cases were selected at
random from a total of 414 non-TIVA general anesthetics. Some patients had more than one operation during the study: as
appropriate for the analysis in question, each operation or each patient was entered as an individual case. For inter-patient
analysis, exposure to 1 or more TIVAs was used to categorize a patient as member of the TIVA group. Results: Excision and
grafting comprised 78.2% of the operations. 14 TIVA regimens were used, employing combinations of 4 i.v. drugs: ketamine
(K, 91 cases); i.v. methadone (M, 62); fentanyl (F, 58); and propofol (P, 21). The most common regimens were KM (34 cases);
KF (26); KMF (16); and K alone (8). Doses used often exceeded those used in non-burn patients. TIVA was preferred for those
patients who were more critically ill prior to surgery, with a higher ASA score (3.87 vs. 3.11). Consistent with this, inhalation
injury (26.7 vs. 1.6%), burn size (TBSA, 36.3 vs. 15.8%), and full-thickness burn size (FULL, 19.8 vs. 6.5%) were higher in TIVA
than in non-TIVA patients. Despite this, intraoperative pressor use was as common in TIVA as in non-TIVA cases (23.9 vs.
22.7%). Conclusions: TIVA was used in patients whose inhalation injury rate and TBSA were greater than those of non-TIVA
patients. TIVA cases were not associated with increased hemodynamic instability. TIVA is a viable approach to general
anesthesia in critically ill burn patients. (IJBT1212001).
Keywords: Total intravenous anesthesia (TIVA), burn, surgery
Address correspondence to: Dr. Leopoldo C Cancio, U.S. Army Institute of Surgical Research, 3400 Rawley E. Chambers
Avenue, Fort Sam Houston, TX, 78234, USA. Phone: 210-916-3301; E-mail: lee.cancio@us.army.mil
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