Necrotizing Fasciitis

Incidence in USA: Approximately 9–11.5 cases of invasive streptococcal infections, from which 1–1.8 die each year

STSS and NF, each comprising an average of 6–7% of these invasive cases, with an associated mortality of 35–50% for STSS and 29% for NF

Predisposing risk factors: Diabetes, peripheral vascular disease, alcoholism, IV drug abuse, immunosuppression, obesity, or malnourishment

Shock, hypoperfusion, organ dysfunction, and hyperglycemia or hypoglycemia

MODS and death

Making an early diagnosis and beginning treatment (which always includes surgical debridement) accordingly, which is the single most important factor to decrease morbidity and mortality

STSS and septic shock

Multiple organ dysfunction, including pulmonary (ARDS), renal, hepatic failure, and hematologic (DIC)

Postop ICU often required

NF constitutes one of the two severe manifestations of GAS, along with STSS, and often is associated with it during its initial presentation.

NF is a common cause of CV collapse, shock, and hypoperfusion, which could be aggravated by the anesthetics. High suspicion is important to ensure early detection and treatment of hypovolemia and hypoperfusion. A suitable anesthetic procedure should be planned. Aggressive and continuous assessment of the CV status is required to have a stable hemodynamic state during sepsis.

Despite the low incidence of the disease, prompt recognition is important given its devastating consequences, not only as a major cause of mortality but also morbidity, including

• Organ failure with long-term requirement of support therapy (i.e., dialysis, home O ₂ )

• Physical disfiguration and amputations causing physical and psychological disability

• Acute and chronic pain syndromes (difficult to control)