Dr Edward Gibson1, Dr Rebecca Cooksey1, Dr Amy Jeeves1, Dr Michelle Lodge1, Mr Darren Molony1, Ms Linda Quinn1, Mr Bernard Carney1
1Women’s And Children’s Hospital, North Adelaide, Australia
Major burns are associated with a hypermetabolic state that can persist for up to twenty four months post injury. In the paediatric population this presents a particularly challenging problem as growth, skeletal development and muscle mass can all be significantly affected. These effects can impact a child’s development and ability to participate in school and sport and reduce the effectiveness of rehabilitation programs. Whilst small in number, there are several studies evaluating therapies, principally propranolol and oxandrolone, aimed at minimising these negative effects of the hypermetabolic state. Our unit has begun trialling these therapies as an adjunct to our usual management for our major paediatric burn cases and we present here our experience.
Case note and online record analysis was performed. Extensive literature review was completed. The unit’s guidelines concerning these medications are outlined.
Propanolol and Oxandrolone are safe and effective therapies in the management of the hypermetabolic state observed in major burns. Monitoring of the impact of these medications is difficult, although they are rarely associated with adverse events, and involvement of a pharmacist is essential. Assessment of the impact of these medications on the individual is challenging as they are utilised to mitigate longer term effects of the hypermetabolic state but results from the literature suggest improved bone mineral density and increased muscle mass as compared with those on placebo. Overall the unit’s experience with these therapies has been positive and they now form an important part of the management of our major burn patients.
Edward is the burns registrar at the Women’s and Children’s Hospital. He is pursuing a career in plastic and reconstructive surgery and has a particular interest in burns care and paediatric plastic surgery. He is a graduate of the University of Adelaide and has a Masters in Surgical Science through the University of Edinburgh.