Anesthetic implications of necrotizing fasciitis

Necrotizing fasciitis, also known as necrotizing acute soft tissue injury (NASTI), commonly occurs as a consequence of group A streptococcal disease. An estimated 9,400 cases of invasive group A streptococcal disease occur annually in the United States, with 600 cases classified as NASTI. Mortality associated with NASTI is estimated at 20% to 50%. Research indicates that early diagnosis and surgical excision of necrotic tissue is the key to minimalization of morbidity and mortality associated with NASTI. Repeated surgeries typically are required in patients with NASTI, posing unusual anesthetic challenges. This article provides an overview of NASTI and includes preoperative, intraoperative, and postoperative anesthetic considerations.