RESUMO
Objective: The identification of the epidemiological characteristics as well as the comparison of the anesthetic techniques of the patients presenting a gangrene of the foot diabetic [general anesthesia versus locoregional anesthesia]
Material and method: Descriptive, retrospective study spread over the year 2013 and realized in the operating block of the emergencies of the military hospital of Rabat. The criteria of inclusion were an age of more than 18 years, and an amputation at the level of the lower limb further to a gangrene evolving in a context of known or inaugural diabetes. The incomplete files were excluded. Various epidemiological, clinical, biological and therapeutic parameters were collected. The various used anesthetic techniques were compared in term of modifications perioperative hémodynamiques, speed to reduce the hyperglycemia, arisen post-operative short-term complication, appeal in the analgesia operating comment as well as the total duration of intervention
Results: During year 2013, 118 patients were listed among which 109 only included. The average age of the patients was 58.3 +/- 11 years old [extremes: 25-86 years] among which 81.6% were male [40 men, 9 women]. The gangrene was localized at the level of a foot [61.5%], of a toe [34.9%], by a leg [2.7%] or of a thigh [0.9%]. The biological characteristics of the patients in the admission were characterized by a hyperleucocytose, hyponatremia, a light acidose and a renal insufficiency. The quantity of the perfused solution in preoperative was 250 +/- 132 mL with administration of an initial bolus of 10 UI of fast insulin. The antibiotic treatment was with amoxicillin/clavulanic acid [66.7%], of cefazolin [22.8%], of amoxicilline/clavulanic acid + metronidazol [6.3%] and of metronidazol only [4.2%]. The used anesthetic techniques were a plexique block [62.2%], a spinal anesthesia [24.7%], a local anesthetic [8.5%] and a general anesthesia [4.6%]. These various techniques were compared in term of modifications perioperative hémodynamiques, speed to reduce the hyperglycemia, arisen post-operative short-term complication, appeal in the analgesia operating comment as well as the total duration of intervention. The quantity of the perfusd solution it peropératoire was 775 +/- 409 mL. The premedication was made by the midazolam. The hemodynamic variations were important in the group spinal anesthesia and local anesthetic. The reduction of hyperglycemia as well as the duration of intervention were more important in the group general anesthesia. The post-operative consequences were marked by the arisen of a hemorrhagic shock at three sick [3.3%] and with a toxic shock at a sick person [1.1%]. Our study showed the advantage to realize plexique blocks compared with the other anesthetic techniques
Conclusion: Our therapeutic protocol which consists of an adapted hydro electrolytic resuscitation e metabolic preoperative and favors plexiques blocks allowed to reduce the incidence of the hemodynamics peroperative variations and the post-operative complications but would require to have patients' more important staff and to be compared with other similar studies