The term electrical burn is used widely to describe the variety of injuries created by supra-physiologic electrical energy interacting with living tissue. The incidence of severe morbidity or mortality is considerably high in electrical burns. This article reviews the problems faced by anesthesiologist while anesthetizing emergency patients with electrical injuries. Retrospective analysis was done in respect to anesthesia technique employed and to evaluate various important factors concerned to an anesthesiologist. Thirty, American society of Anaesthesiologist grade III/IV patients were operated for emergency fasciotomy, debridement, limb amputation or disarticulation, subclavian artery ligation surgeries. General anesthesia with intubation or GA with Total Intravenous Anaesthesia was given in 26.6% patients. Regional anesthesia, brachial plexus block in 20% patients and spinal anesthesia in 26.6% patients was given. Anesthesia related difficulties included difficult venous cannulation (8O0/0), monitor application (6O0/0), difficult airway (1 3.3%), selecting anesthetic drugs and technique used in patients having hypokalemia (60°/0), septicemic shock (1 3.3%) and acute renal failure (6.6%).

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Burn injuries are fairly common in children. The approach to a victim of pediatric burn injury includes a comprehensive approach and a team work right from first aid to medical treatment, surgical intervention and rehabilitation. Here we have stressed the important aspects of assessment and evaluation, medical management and appropriate surgical methods for a child with burn injury.

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An epidemiological study of burns patients with pregnancy was carried out to know the magnitude, distribution and etiology. It also gives information for formulation of policies for prevention and control of diseases. A retrospective study of burns patients came to Civil Hospital Ahmedabad from January 2003 to December 2005 was carried out. The data were analyzed regarding age, parity, gestational age, type and mode of burns, place, and foetal and maternal morbidity and mortality. Most of our patients were accidental and thermal burns. Most common affected age group was between 20-30 years of age with total body surface area burned (TBSA) ranging from 20-8O0/0. In minor degree burns foetal and maternal outcome was good. While in cases of major degree burns i.e. >60% or 40% burns, morbidity and mortalitywas very high.

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A burn victim is entitled to compensation for current and future medical expenses, lost wages, disfigurement, emotional suffering, mental impairment, and physical disability. The concept of physical impairment has to evolve amongst the burn specialist so that the award of disability can become more meaningful. It must be realized that disability is not purely a medical condition. The article describes the difference between concepts of physical impairment and disability and guidelines to quantify permanent physical impairment.

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Although, highly specialized burn centers have significantly reduced mortality rates following extensive total body surface area burns, survivors are often left with grotesque facial disfigurement. Hypertrophic scars and tissue defects are the most common cause of functional and aesthetic problems in the head and neck region. Various options from split skin grafts, full thickness grafts, local and pedicled flaps and free flaps are available for correction of these deformities. Micro vascular free flaps have turned out as a promising answer for many difficult conditions, both in acute stages as well as in late elective procedures, for aesthetic reconstruction of face. Over a period of fifteen months from Jan 2006 to April 2007, six free flaps were done in patients of post burn facial deformities, of which three were lateral arm flaps and three scapular flaps.

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This article is about management of a 1 l/2 month old child with severe microstomia with absent mouth opening following accidental perioral acid burns. Oral intubation was not possible and such small fibre optic scope was not available. Patient was managed per operatively by using small portex tube as nasal airway with spontaneous breathing as surgeon quickly released the microstomia and controlled bleeders

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Burns sustained during pregnancy have been reported as having an adverse effect on maternal and foetal survival. A retrospective study dealing with patients having burns during pregnancy from January to December 2005 was done. In this period, 30 patients having burns during pregnancy were admitted to Civil Hospital, Ahmedabad. The age group most affected was between 20-30 years. Burns accident occurred commonly during 1st trimester and 3rd trimester of gestational age. The upper limbs, head and neck and abdomen were the most commonly affected parts of the body. In most of the cases, some social factor was associated with burns rather than an accident. The maternal mortality and the neonatal mortality in cases of major degree burns were very high as compared to minor degree burns.

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In a prospective study over a period of one year, 8 epileptics were treated for acute thermal burn or its sequelae. All the burns were sustained during epileptic seizure. 4 cases were admitted with acute thermal burn while the remaining 4 cases were admitted with burn sequelae i.e.1 case with Marjolin's ulcer over burn scar on right leg, 1 case with ectropion of both upper eyelids and 2 cases with nonhealing ulcer over left leg & left arm respectively. Out of 8 cases studied, 2 cases had sustained second episode of burn. All the patients were females, age ranging from 18 to 50 years. All the patients sustained burns while cooking on unguarded open fire except 1 who sustained burn while warming hands on fire. Percentage of burn varied from 3 O/O to 85 %.One patient with 85 O/O deep thermal burn died during treatment. Out of 8 patients, 6 patients had never taken antiepileptic drugs despite frequent seizures with loss of consciousness; remaining 2 patients had taken irregular, inadequate treatment for sometime and then stopped it: Poverty, illiteracy, unawareness, ignorance and superstitions of the patients that seizure are due to some bad supernatural powers and epilepsy being considered a social taboo are factors that prevent patients from taking treatment. Patients need to be educated and motivated to take adequate and regular treatment for optimal seizure control. Involvement of government & nongovernmental organizations are stressed to eradicate the myths, educate the patients and their cohabitants regarding proper and regular medications for epilepsy, so as to keep it in control lest it leads to further burns in kitchen.

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Difficult airway intubation is predicted in cases of severe post burn neck contracture, which can be life threatening and can result in multiple serious complications and sequelae. We studied fifteen patients with age ranging from 15- to 60 years, who were operated under local tumescent anaesthesia supplemented with intravenous ketamine for release of post burn neck contracture and split thickness skin grafting. This method obviates the need for endotracheal intubation. No complications were attributed to this anaesthesia technique.

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This article shows unusual detection of hypothyroidism in an elderly burn patient and its association with the burn injury

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Mucormycosis is a dreadful condition. Although few cases of mucormycosis in patients suffering from burn have been reported, literature has yet to report a case of mucormycosis at the intravenous cannula site, in patients suffering from severe burns. A 30 year old male labourer sustained 50% 2nd and 3rd degree flame burns. On the 6th day he developed mucormycosis at the intravenous cannula site around right elbow with severe septicemia. On debridement the underlying muscles and median nerve were found to be necrosed with thrombosis of brachial artery just above the elbow. Higher antibiotics and systemic amp hotericin B were administered to counter bacterial as well as fungal septicemia. Multiple debridements were required and split thickness skin graft was applied to cover the raw area. The underlying necrotic medial epicondyle of humerus had to be removed also. Sustained efforts were required not only to save the life of the patient but also to salvage the right upper limb of this young manual worker. The patient now requires tendon transfers to improve his hand function further.

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Various methods of reconstruction are available for post burn facial deformities ranging from split thickness skin grafting to full thickness skin grafting or loco regional flaps to free flaps. Serial scar excision and tissue expansion are also important armamentarium in the hands of a burn surgeon. Extensive literature is available regarding epidemiological factors of burns, its causes, pattern and type of burns affecting facial region, but a very few studies show the comparative results of different surgical options available for similar conditions. This prospective study was designed to compare the outcome of these different surgical procedures in terms of their advantages, limitations, duration of hospitalization, cost effectiveness, as well as patient and surgeon satisfaction level. Over a period of three years from Feb 2004 to Feb 2007, 56 procedures were performed in 40 patients. Microvascular free flaps have turned out as a promising answer for many difficult conditions, both in acute stages as well as in late elective procedures, for aesthetic reconstruction of face. Full-face excision and grafting should be considered in badly affected faces.

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Halothane has enjoyed popularity as the inhalational agent of choice for paediatric anaesthesia. As sevoflurane was introduced as a new volatile anaesthetic agent with rapid induction and recovery, this study was undertaken to compare induction characteristics, hemodynamic stability and conditions for endotracheal intubation using sevoflurane and halothane. 20 ASA grade I and II children between 1 - 12 years of age were randomly divided into two groups. Group-l patients were induced with halothane starting from 0.5% with gradual increment to 3%, while group II patients were induced with sevoflurane starting with 1% with increments up to 6%. Centralization of eyeballs with constriction of pupil was considered to be the end point for endotracheal intubation. Time interval from application of mask to eyeball centralization for group I was 222.83 + 50.37 seconds and group II was 178.89 + 48.1 1 seconds (P<0.05). Conditions for endotracheal intubation were found comparable in both the groups. Heart rate was better maintained with sevoflurane than the halothane (P<0.05). The incidence of excitement and adverse airway events were few in both the groups. Thus, it can be concluded that sevoflurane has a rapid and smooth induction and is a suitable alternative to halothane for inhalational anaesthesia in post burn contracture (PBC) neck surgeries in children.

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