Levytska O. V., Dubivska S. S.

PERIOPERATIVE STRATEGY FOR MAJOR AMPUTATIONS IN PATIENTS WITH DIABETES, OBESITY AND HEART FAILURE: THE ROLE OF MULTIMODAL ANESTHESIA

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About the author:

Levytska O. V., Dubivska S. S.

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CLINICAL AND EXPERIMENTAL MEDICINE

Type of article:

Scientific article

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Patients with obesity, systolic myocardial dysfunction, and diabetic foot syndrome (DFS) who require high lower limb amputations are at extremely high anesthetic risk. The aim of the study was to evaluate the effectiveness of a multimodal anesthetic approach combining unilateral spinal anesthesia, intraoperative dexmedetomidine sedation, and postoperative regional block compared with traditional spinal anesthesia. A prospective randomized study was conducted on 50 patients (25 in each group). The control group received only unilateral spinal anesthesia, while the main group received a combined technique. Mean arterial pressure, perfusion index (PI), visual analog scale (VAS) pain intensity, glycemia, and cortisol levels were assessed in the perioperative period. The results showed that patients in the main group had more stable hemodynamic parameters, better PI, significantly lower postoperative pain, and reduced glycemia and cortisol compared to the control group. Thus, multimodal anesthesia using dexmedetomidine and regional blockade provides more effective analgesia, hemodynamic stability, and reduced stress response, making it a priority approach in patients at high cardiovascular risk.

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Publication of the article:

«Bulletin of problems biology and medicine», 2025 Issue 3,178, 192-201 pages, index UDC 617.55-089.5:616.379-008.64-089.843:616.12-008.46

DOI:

10.29254/2077-4214-2025-3-178-192-201