Vô cảm cho phẫu thuật cắt hoại tử bỏng ghép da ở bệnh nhân tăng men gan phản ứng (Thông báo lâm sàng).

Abstract

Introduction: Anesthesia for necrosis excision and skin graft in burn patients with reaction elevated liver enzymes is not common. On April 3, 2018, we made general anesthesia with laryngeal mask airway for necrosis excision and skin graft on a burn patient with reaction elevated liver enzymes.
Case report:A 49-year-old female, a healthy history, suffered from the flame burn at 11 o'clock on March 27, 2018, and transferred to the Intensive Care Unit (ICU) of National Burns Hospital at 16 o'clock on March 27, 2018, in a state of consciousness sedation, pale mucous and skin, temperature 36⁰8C, pulse 94 bpm, blood pressure 132/74mmHg, spontaneous breathing with SpO₂ 98%, urine output 300ml/4hrs. Local lesions included a total burn surface area of 18% (15%) at the third and fourth degrees on the face, the back, both hands, both buttocks, left thighs, burn shock at the 5^th hour.
On March 29, 2018, blood test results showed Protein 43g/l, Albumin 21g/l, total Bilirubin 35.7µmol/l, direct Bilirubin 14.5µmol/l, GOT 5513U/l, GPT 3020U/l, Na⁺ 119.7mmmol/l, K⁺ 3.35mmol/l, Ca⁺⁺ 0.94mmol/l, Glucose 8.7mmol/l. On March 29, 2018, the Department of Gastroenterology of Hospital 103 examined no history of hepatobiliary disease, soft abdomen, no large liver and spleen. The patient was diagnosed with toxic hepatitis. On April 3, 2018, she was transferred to the operating room with a preoperative diagnosis 11% of total body surface area of necrosis on limb and trunk. The surgical method was necrosis excision and skin graft. The anesthesia method was general anesthesia with a laryngeal mask airway.
 Conclusion: Anesthesia for burn necrosis excision and skin graft in patients with reaction elevated liver enzymes needs full and detailed evaluation before anesthesia and surgery. The patient's condition before surgery must be managed optimally. Choosing appropriate anesthesia methods and intraoperative careful monitoring are important factors for successful surgical anesthesia in the patients.