Management of patient with necrotizing fasciitis: a challenge for anaesthesiologist

Authors

  • Reena Mahajan Department of Anaesthesiology, S.H.K.M. Govt. Medical College, Nalhar, Mewat, Haryana
  • Suchitra Malhotra Department of Anaesthesiology, S.H.K.M. Govt. Medical College, Nalhar, Mewat, Haryana

Keywords:

Sepsis, Anaesthesia, Necrotizing fasciitis

Abstract

Necrotising fasciitis, a highly lethal infection of deep seated subcutaneous tissue and fascia, is associated with high mortality and long term morbidity. A five year old child of necrotizing fasciitis with poor general condition, deranged investigations and unstable vitals was posted for debridement. After initial resuscitation, TIVA was given, intraoperative period was uneventful and post operatively patient was shifted to recovery room as fully conscious with O2 by face mask. After 1½ hours, patient became drowsy, hypotensive with bradycardia and urine output was nil. Immediate resuscitation started and vasopressors added. Despite all aggressive interventions, the patient died due to sepsis induced multiorgan failure. Blood samples and wound aspirate culture showed group A beta hemolytic Streptococcous. In this case report we discuss the best possible management of such patients and tried to minimize several barriers like lack of early recognition of severe sepsis and septic shock, treatment delay, lack of several investigations and drugs, shortage of health care providers, absence of locally written protocol, remote area and tried to give the massage that adherence to published guidelines for the management of severe sepsis patients lowers mortality.

References

Eissa D, Carton EG, Buggy DJ. Anaesthetic management of patients with severe sepsis. Br J Anaesth. 2010;105(6):734-43.

Baluch A, Janoo A, Lam K, Hoover J, Kaye A. Septic shock: review and anaesthetic considerations. MEJ Anesth. 2007;19(1):71-86.

Wong CH, Khin LW, Heng KS, Tan KC, Low CO. The LRINEC score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections. Crit Care Med. 2004;32(7):1535-41.

Luzzani A, Polati E, Dorizzi R, Rungatscher A, Pavan R, Merlini A. Comparison of procalcitonin and C-reactive protein as markers of sepsis. Crit Care Med. 2003;31(6):1737-41.

Roach AC. Antibiotic therapy in septic shock. Crit Care Nurse Clin North Am. 1990;2(2):179-86.

Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345:1368-77.

He´bert PC, Wells G, Blajchman MA, Marshall J, Martin C, Pagliarello G, et al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. N Engl J Med. 1999;340:409-17.

Stoelting R, Dierdorf S. Early goal-directed resuscitation. In: Stoelting R, Dierdorf S, eds. Anaesthesia and Co-existing Disease. 4th ed. London: Churchill Livingstone; 2002: 571-584.

Brunkhorst FM, Engel C, Bloos F, Meier-Hellmann A, Ragaller M, Weiler N, et al. Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N Engl J Med. 2008;358:125-39.

Surviving Sepsis Campaign. Guidelines, 2012. Available at: www.survivingsepsis.org/guidelines.

Edwards JD. Practical application of oxygen transport principles. Crit Care Med. 1990;18:S45-8.

Bernard GR, Vincent JL, Laterre PF, LaRosa SP, Dhainaut JF, Lopez-Rodriguez A, et al. Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med. 2001;344:699-709.

Laterre PF, Levy H, Clermont G, Ball DE, Garg R, Nelson DR, et al. Hospital mortality and resource use in subgroups of the Recombinant Human Activated Protein C Worldwide Evaluation in Severe Sepsis (PROWESS) trial. Crit Care Med. 2004;32:2207-18.

van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, et al. Intensive insulin therapy in the critically ill patients. N Engl J Med. 2001;345:1359-67.

Allaouchiche B, Duflo F, Tournadre JP, Debon R, Chassard D. Influence of sepsis on sevoflurane minimum alveolar concentration in a porcine model. Br J Anaesth. 2001;86:832-6.

Taviloglu K, Yanar H. Necrotizing fascitis: strategies for diagnosis and management. World J Emerg Surg. 2007;2:19.

Guay J. Benefits of adding epidural analgesia to general anesthesia: a meta-analysis. Br J Anaesth. 2006;20:335-40.

Schuz-Stubner S, Pottinger JM, Coffin SA, Herwaldt LA. Nosocomial infections and infection control in regional anaesthesia. Acta Anaesthesiol Scand. 2008;52:1144-57.

Downloads

Published

2017-01-07

How to Cite

Mahajan, R., & Malhotra, S. (2017). Management of patient with necrotizing fasciitis: a challenge for anaesthesiologist. International Journal of Research in Medical Sciences, 3(3), 763–766. Retrieved from https://www.msjonline.org/index.php/ijrms/article/view/1371

Issue

Section

Case Reports