Anesthetic management of diabetic foot amputation in a patient with renal failure and maintenance hemodialysis: case report and short communication

Chronic kidney disease (CKD) can progress to an advanced stage, eventually developing into end-stage renal disease (ESRD). Currently, the only effective treatment for ESRD is renal replacement therapy, with maintenance hemodialysis (MHD) being the most widely used modality, accounting for approximately 90% of all dialysis patients. However, the perioperative risk of surgery and anesthesia in these patients remains extremely high. Therefore, careful selection of surgical timing, appropriate anesthetic agents, and suitable anesthetic techniques is crucial. This report describes the anesthetic management of a 62-year-old female patient who had been hospitalized in the orthopedic ward for nine months due to left toe necrosis secondary to diabetic foot, in the setting of CKD requiring MHD. She was later admitted to Xingtai Central Hospital with progressive necrosis involving the left second and third toes and extending to the dorsum and plantar aspect of the foot. The patient was diagnosed with left-sided diabetic foot necrosis, stage 5 CKD, type 2 diabetes mellitus with multiple complications, grade 3 hypertension (high risk), and chronic hepatitis B infection. An elective transtibial (below-knee) amputation of the left lower limb was planned. Anesthesia was provided using color Doppler ultrasound-guided left iliac fascia block, left lateral femoral cutaneous nerve block, and left sciatic nerve block. Intravenous isoproterenol infusion, dexmedetomidine, and dizocine injection were administered for intraoperative sedation and analgesia. The patient's intraoperative vital signs remained stable. Postoperatively, the patient was awake, in good general condition, and was transferred to the ward with regular monitoring.