Anaesthetic Management of a Case of Post Burns Contracture Coming for Contracture Release

Abstract

Most common postburn problem that requires management by the burn reconstructive surgeon are post burn contractures. They are characterized by tight, shortened scar tissue which form over joints, creating a limitation of movement therefore create a deformity as they form defect over anatomic structure. Contractures may involve skin, with shortening or fibrosis of underlying muscle, fascia, and joint structures. Oral, facial and burns involving neck are challenging because nose and extrernal nare can be fibrosed and reduced mouth opening can be present which may be an important factor for difficult airway. Neck contractures may reduce atlanto occipital joint extension which also aids for difficult airway. Here we report a case of post burn contracture came for contracture release with anticipated difficult airway managed well with awake fiber optic bronchoscopic  intubation.The reported incidence of difficult intubation is 5.85%, cannot intubate situation is 0.35% and cannot ventilate - cannot intubate situation is 0.02% and these can be major causes of anaesthesia-related morbidity and mortality(1)