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B198 Anaesthetic management of the patient with sepsis, recent myocardial infarctionand gastrointestinal bleeding undergoing above knee amputation
  1. A Masoodi1,
  2. D Dziuba2 and
  3. O Loskutov2
  1. 1Kyiv Regional Clinical Hospital, Kyiv, Ukraine
  2. 2Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine


Background and Aims Despite current aggressive revascularization and limb salvage management, peripheral arterial disease (PAD) contributes to more than half of all amputations. The second Trans-Atlantic Inter-Society Consensus Working Group (TASC II) reported an incidence of major amputation as a result of PAD of 12 to 50 per 100,000 individuals a year.Peripheral nerve blocks are ideal for high-risk surgical patients who cannot tolerate the adverse consequences of even the slightest attenuation of haemodynamic response.

Methods In this report, a74 -year-old man with sepsis,recent myocardial infarction and gastrointestinal bleeding, presents for an urgent above knee amputation. WThe pre-operative clinical assessment of his condition revealed sepsis. He has got cardiac failure the day before surgery with Troponin I level 14687.20 ng\L and had a resting blood pressure 110/78 mm Hg. He also had gastrointestinal bleeding from stomach ulsers which stoped before surgery and level of Hb dropped from 14g\l to 9/5 g\l. To minimise any haemodynamic disturbance, a combined sciatic-femoral nerve block with epidural catheter placement for postoperative analgesia were planned for the surgery. The vital signs were maintained to within 20% of baseline with IV fluids.

Results Regional anaesthesia technique, showed a significant reduction of peri-operative morbidity with regard to deep vein thrombosis, pulmonary embolism, transfusion requirements, pneumonia, respiratory depression, myocardial infarction and renal failure in patients who had received neuraxial blockade instead of general anaesthesia.

Conclusions Combination of regional anesthesia techniques and low dose of anesthetics allow to avoid hard complications at patients with high-risk diseases and optimize pain relief for them.

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