The perioperative management of patients with musculoskeletal disease and for the burns patient

Musculoskeletal disease may exist as a single or multi-system disorder and affects patients in all age groups. Pre-anaesthetic assessment should be focussed on defining the extent of both musculoskeletal disease and systemic disease, and consideration will need to be given to the management of medications in the perioperative period. Limited joint mobility can hinder dynamic preoperative assessment of cardiorespiratory reserve. The range of neck movement will influence the choice of anaesthetic technique and this should be planned well in advance of surgery. The need for postoperative high dependency or intensive care should be anticipated. Patients with burns present many potential problems in both the acute and longer term. Protecting the airway from rapid swelling is an urgent priority in the acute phase. Large burn injuries cause systemic changes in fluid balance, temperature control and metabolic rate. Long-term changes in physiology, pharmacokinetics and mental state need to be considered when planning perioperative care.