Anaesthetic Challenges in the Surgical Management of Diabetic Foot Disease at Enugu

Abstract

A review of the anaesthetic management of lower limb amputations consequent upon diabetes foot disease, carried out at the University of Nigeria teaching Hospital Enugu over a five year period, (April 1998 toMarch 2003) wasmade.
Aim: was to identify those anaesthetic problems frequently encountered during the operative procedure, relate them to the outcome of the entire management and to proffer possible solutions to these problems.
Method: Clinical notes of all cases of lower limb amputation were assembled and those due to diabetic gangrene were selected. Relevant data were extracted frompre-operative notes, the anaesthetic charts and the post-operative records.
Result: Thirty two (32) case notes belonging to twenty three (23)males and nine (9) females, aged 27-73 yearswere reviewed. Anaemia, septicaemia, fever and uncontrolled blood sugar levels were recorded in all the cases. Operationwas delayed for periods between 16 hours and 8 days in the series. Regional anaesthesia (sub-arachnoid block) was used in 81% of the cases while the rest hadGeneral anaesthesia. Blood pressure, electrocardiogram, oxygen saturation, blood sugar and urine output weremonitored intraoperatively. All the patients received blood transfusion as well as slowintravenous infusion of glucose / potassium/ insulin
(GKI). Therewere six (6) deaths in the series, allwhich occurred in the first 24 hours of the operation. Themortality in this study was seen only in males, and all related to delay in accepting the operation, the degree of sepsis and fasting blood sugar level.
Conclusion: Diabetics for gangrenous lower limb amputation are high risk patients. Surgery should be carried out soon after the decision to amputate and anaesthesia should only wait for those clinical investigations necessary to control and stabilize the patients.Adequate preoperative fluid therapy, intra-operative glucose / potassium / insulin therapy and monitoring of blood sugar and cardiovascular status are necessary for the success of the procedure. Morbidity and mortality are related to blood
glucose levels, degrees of infection and delay in accepting the surgery.

Niger Med J. Vol. 49, No.3, July– Sept, 2008: 59 – 62.

Keywords: Diabetes, gangrene,Anaesthesia,Amputation