Above knee amputation in a geriatric patient with severe ICMP and DM2: A case report

Abstract

Geriatric patients with cardiac dysfunction are always a nightmare for anaesthetist in terms of successful intraoperative and postoperative management. We are presenting a case of 68-year-old male patient admitted in surgical emergency with rapidly progressive wet gangrene of right leg. He was a diagnosed case of severe Ischemic cardiomyopathy (ICMP) and Diabetes mellitus type 2 (DM-2) since last 10 years on medications. However, he was non-compliant with medications and had developed severe limitation in the functional status with metabolic equivalents <4 (METs<4) and complaints of chest pain even on minimal exertion. In view of the rapidly progressive wet gangrene and risk of sepsis leading to high possibility of morbidity and mortality, an urgent above knee amputation was planned. However due to the risks associated with general anaesthesia and central neuraxial blockade, an safe anesthesia plan was formulated and implemented utilising only the lower limb blocks to achieve a safe conduct of anaesthesia.