AANA journal. 71, no. 1, (2003): 37
This is a review article. It focuses on the issue of
anesthesia for cases of necrotizing fasciitis. There are several key
considerations to keep in mind. Untreated cases often present as septic shock
requiring vasoactive drug administration. Mortality can be as high as 20 to 50
%. These patients definitely require some form of invasive monitoring of
hemodynamics and vigorous volume resuscitation. Infected dead tissue tends to
bleed and blood products should be readily available. Clotting factor
deficiencies may also need replacement. As a rule, multiple surgeries will be
required and should be prepared for. In some severe tracheostomy may be
indicated along with ICU care. These patients will require pain management,
physical therapy and often psych consultations. Intraoperatively, anesthesia
provider should be prepared to deal with large fluid shifts, hemodynamic
instability, and frequent positioning changes, as well as the use vasoactive
drugs.
No comments:
Post a Comment