Anaesthetic management and surgical debridement of Fournier’s gangrene in a 65-year-old male in acute decompensated heart failure in a resource-limited tertiary hospital: A case report.

Abstract

Emergency surgical interventions in patients with significant cardiovascular comorbidities present complex anaesthetic challenges, particularly in resource-limited settings. Fournier’s gangrene is a rapidly progressive necrotising infection that requires urgent surgical debridement. This further complicates the management of severe cardiac dysfunction.

This case report presents the anaesthetic management of a 65-year-old male patient with Fournier’s gangrene and acute heart failure.  He had dilated cardiomyopathy with an ejection fraction of 26%, with comorbid atrial fibrillation, obesity, hypertension, diabetes, and sepsis. He presented in respiratory distress, renal impairment, and, functionally, New York Heart Association Class IV.

 A right radial arterial line and an internal jugular central line were inserted, with a low-dose dobutamine infusion initiated before induction. He was induced slowly with etomidate and midazolam, with fentanyl and lignocaine given for blunting the sympathetic response. Sevoflurane was used for maintenance of anaesthesia, with inotropic support in the form of adrenaline added intra-operatively. Fluid requirements were 11.7ml/kg. He remained intubated and transferred to the ICU, where inotropes were weaned off, and respiratory recovery was achieved. He improved and was followed up post-operatively over a period of three months.

The case illustrates that optimal outcomes are achievable in patients with severe heart failure and sepsis through careful pre-operative optimisation, judicious induction, appropriate inotropic support, and postoperative critical care, in a resource-limited environment.