{'fraction_non_alphanumeric': 0.031571722717913524, 'fraction_numerical': 0.012354152367879203, 'mean_word_length': 4.855421686746988, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Burns treatment in the 21st century: a challenge for British anaesthesia

The management of major burns has undergone radical change in recent years. Now is a good time to reflect on that change and the implications it presents for anaesthesia. These implications will be felt in anaesthesia, acute pain, intensive care and patient transfer services – with much to be discussed in each of these areas. The foundation for development was the work many years ago of MacMillan [1], Jackson et al. [2], Jancekowicz [3] and others, who described early surgical removal of the burn wound. However, surgeons were unable to achieve this in burns of any magnitude because, in such patients, donor sites were fewer and therefore early wound closure was less possible [4]. There was, furthermore, a tacit understanding that the ‘shock’ of a second, surgically induced injury soon after a massive burn would be detrimental to a patient requiring intensive care. Little wonder that patients with more than 40% of total body surface area (% tbsa) burned had a high mortality [5], especially if associated with inhalation injury. Burn Units [6] were developed in the UK in the 1950s and 1960s primarily as centres for treatment of burn shock, prevention of infection and, in some cases, to support research. For historical reasons often related to warfare, many grew up isolated from some or all supporting disciplines of whose services they then had little apparent need.