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