The decision was made to take the patient to the operating
room for tracheostomy and escharotomy in order
to obtain a more secure surgical airway and to improve
chest excursion. The surgical team placed a 12F triplelumen
catheter in the patient’s left femoral vein in preparation
for the procedure. The patient was transferred to the operating room
with the 5.5-mm ETT in place. Standard monitors were
applied. Lactated Ringer’s solution was given rapidly
through all 3 lumina of the femoral vein catheter. The
patient was connected to the breathing circuit of the
anesthesia machine and was given 1.5% to 3.0% sevoflurane
in 100% oxygen along with IV cisatracurium, 20
mg. The patient was hand ventilated for the entire case in
order to continually evaluate lung compliance. Even with
small rapid breaths, airway pressures were as high as 46
cm H2O during the operation. Forced warm-air heating
was applied, since hypothermia can have perilous consequences
for burned patients