Perioperative management of patients with musculoskeletal disease and for the burns patient

Musculoskeletal disease may present as isolated joint disease, a severe multisystem disorder or a neuromuscular disorder affecting the musculoskeletal system. Thorough preoperative assessment is essential to plan the surgical management of this group of patients. Assessment of the severity of cardiorespiratory disease may be difficult with severely limited mobility. The airway and neck may be involved so early anaesthetic opinion is essential. Drug therapy may need to be modified or stopped perioperatively. Intraoperative positioning and thermoregulation can be difficult to achieve and postoperative analgesia needs to be carefully planned to avoid respiratory depression in this vulnerable group. Patients with burns may present in the emergency department for urgent assessment, or for early surgery to excise the burn and graft the defect. There may be an inhalational injury which, if severe, will require urgent treatment often with intubation and intensive care unit care. A major burn is also a multisystem disorder and again there are challenges with airway management, positioning and thermoregulation. These patients present for repeated surgeries and can suffer extreme emotional and psychological strain as a result of the burn insult.