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Anesthesia for the DLS Patient: Minimizing Risk and Maximizing Safety

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Functional Limb Salvage

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Abstract

Diabetic limb salvage (DLS) patients present a challenging perioperative course due to comorbidities involving multiple organ systems. These challenges lead to an increased risk of morbidity and mortality in the perioperative period. The demands of the DLS patient population require preoperative medical optimization, intraoperative risk mitigation, and enhanced postoperative recovery.

Surgery induces a stress response throughout multiple organ systems. In a healthy patient, this stress response can be well tolerated; however, DLS patients may not tolerate these same conditions due to medical comorbidities. In order to improve outcomes, DLS patients must have their medical conditions optimized prior to surgery.

Despite medical optimization, the anesthetic technique utilized should cause the fewest physiologic changes in an effort to decrease morbidity and mortality. The options include general anesthesia, regional anesthesia, or a combination of both strategies. The choice of technique should be tailored to each patient.

In the postoperative setting, adequate pain control is essential to reduce morbidity and mortality and improve recovery. The focus should be to prevent and treat Residual Limb Pain (RLP) and Phantom Limb Pain (PLP). An acute pain service (APS) can help achieve this goal using a multitude of medications and interventions such as neuraxial and perineural catheters.

The perioperative surgical home (PSH) was developed to form a multidisciplinary collaboration in the optimization for surgery and postoperative care. Early involvement of anesthesia providers and the acute pain service (APS) are crucial to achieving the goals surrounding this patient population. This collaboration will improve patient outcomes and prove cost-effective for the healthcare system.

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Authors and Affiliations

  1. Regional Anesthesia and Acute Pain Medicine, MedStar Medical Group Anesthesiology, Baltimore, MD, USA

    Kasra Razmjou

  2. North American Partners in Anesthesia, Melville, NY, USA

    Andy Liao

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  1. Kasra Razmjou
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  2. Andy Liao
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Correspondence to Kasra Razmjou .

Editor information

Editors and Affiliations

  1. Department of Plastic Surgery, Georgetown University School of Medicine and MedStar Georgetown University Hospital, Washington, DC, USA

    Christopher E. Attinger

  2. Department of Plastic Surgery, Georgetown University School of Medicine and MedStar Georgetown University Hospital, Washington, DC, USA

    John S. Steinberg

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Razmjou, K., Liao, A. (2023). Anesthesia for the DLS Patient: Minimizing Risk and Maximizing Safety. In: Attinger, C.E., Steinberg, J.S. (eds) Functional Limb Salvage. Springer, Cham. https://doi.org/10.1007/978-3-031-27725-2_11

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  • DOI: https://doi.org/10.1007/978-3-031-27725-2_11

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  • Online ISBN: 978-3-031-27725-2

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