Laser treatment for burn scar

Laser treatment for burn scar

Anesthesia type	MAC orGeneral
Airway	LMA or Natural Airway
Lines and access	PIV x1
Monitors	Standard
Primary anesthetic considerations
Preoperative
Intraoperative	Intraoperative laser
Postoperative	Pain control
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Editor rating	Unrated
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Overview

CO2 lasers resurfacing is a surgical procedure used to improve the appearance of hypertrophic scars from burns or other trauma. The CO2 lasers help to remodel and redistribute dermal collagen fibers, flattening and softening them to reduce scar thickness and improve functionality. It is often combined with local 5-Flurouracil injections and steroid injections for further collogen breakdown and fibroblast inhibition.

Laser treatments for scars usually take 3-8 sessions spaced 4-8 weeks apart for optimal scar and mobility improvements.

Preoperative management

Patient evaluation

System	Considerations
Airway	Airway evaluation, consideration for natural airway vs. LMA vs. ETT
Neurologic	Outpatient pain medication
Cardiovascular	CAD, CHF
Pulmonary	Smoking hx
Gastrointestinal	GERD
Other	Skin infections

Labs and studies

Labs and studies should be aimed at patient comorbidities

Operating room setup

Ensure proper laser-approved eye-protection for both patient and physician

Patient preparation and premedication

Premedication with Tylenol for pain is recommended for patients with good hepatic function

As this is an outpatient procedure, premedication with benzodiazepines are discouraged to ensure appropriately timed PACU course. However, lorazepam PO can be taken prior to the procedure for severely anxious patients.

Intraoperative management

Monitoring and access

Standard Monitoring

PIV x1

Induction and airway management

Procedure can be done under MAC or general anesthesia. General anesthesia can be done with a natural airway, LMA, or ETT with consideration to airway patency.

Maintain spontaneous ventilation if using natural airway or LMA

Positioning

Supine

Maintenance and surgical considerations

• Propofol infusion
• IV opioids

Emergence

Natural airway: cessation of maintenance anesthetic

LMA: able to remove LMA in deep plane of anesthesia if patient is breathing spontaneously and ventilating/oxygenating appropriately

Postoperative management

Disposition

PACU to home

Pain management

• Acetaminophen
• Ibuprofen
• Oral opioids

Potential complications

Laser fire (more likely with facial procedures)

Procedure variants

	Variant 1
Unique considerations	Eye protection for laser use
Indications	Hypertrophic scar reduction
Position	Supine
Surgical time	30-60 minutes
EBL	Minimal
Postoperative disposition	Outpatient
Pain management	Tylenol, ibuprofen
Potential complications	Laser fire