A 43-year-old man with chronic alcoholism was admitted to the hospital, subsequent to the destruction of his room by fire. He had sustained second- and third-degree burns which were estimated to involve 25% of his body surface area. The injuries involved his back, left arm, legs, and minor burns about the face. Initial hospital management was difficult, due to failure of cooperation and the development of delirium tremens. He remained febrile with a temperature of 100 to 102 F (37.8 to 38.9 C), and tachycardia was noted. Chest roentgenograms (Fig 1), electrocardiogram, serum electrolyte concentration, and hemoglobin level were within normal limits.
On the 14th hospital day, the patient was brought to the operating room for debridement of the burns on his left arm and placement of a splint to correct incipient contractures. Because of the probability of respiratory tract injury, as reflected by voice loss, a regional anesthetic technique