Peri-operative Anesthetic Management for Patients with Perforation Peritonitis
Mohammed Mohammed EL metwally;
Abstract
Peritoneal membrane is a semi-permeable membrane that lines the abdominal wall (parietal peritoneum) and covers the abdominal organs (visceral peritoneum). The membrane is a closed sac in males. The fallopian tubes and ovaries open into the peritoneal cavity in females. The size of the membrane approximates the body surface area (1-2 m2). There are about 100 cc of transudate that is contained in the cavity in normal individuals.
Peritonitis is the inflammation of the peritoneum. It is caused by a bacterial or fungal infection. There are two major types of peritonitis. The common age for its occurrence has been reported to be 45-60 years.
Many of the systemic as well as abdominal manifestations of peritonitis are mediated by cytokines.
Peritonitis presents as an acute abdomen. Abdominal pain is the most important symptom of generalized peritonitis.The examination should focus on the state of intravascular hydration, the presence of shock or multi organ dysfunction and the adequacy of hemodynamic resuscitation.
Investigations which are recommended in patients are complete blood count including platelet count, serum electrolytes, liver and kidney function tests, blood sugar and electrocardiogram.
The objective of pre-operative resuscitation is to rapidly restore adequate oxygen delivery to peripheral tissues. Most patients are hypovolemic from the massive sequestration of fluid into the peritoneum and into the lumen of gut.
Hemodynamic resuscitation, the use of appropriate antibiotics and correction of any abnormalities are essential pre-operative items.
Surgical therapy alone may be sufficient to cure otherwise healthy young patients who have no signs of severe sepsis, hence should never be delayed unnecessarily.
The primary goal of anesthesiologist during the intra operative period is to provide safe and optimal care. General anesthesia with endotracheal intubation and controlled ventilation is the technique of choice.
In all critically ill patients, analgesia, sedation and mechanical ventilation are maintained at the conclusion of surgery. Safe transportation of the patient to the ICU and elaborate handover should also be ensured.
In ICU, Cardio-respiratory support is necessary. Antimicrobialtherapy should be continued.Intravenous hydrocortisone may be considered.
Nutrition is one of the corner stones of management in these patients and adequate glycemic control is important.
Other therapies may be needed, e.g. renal replacement therapy as well as prophylaxis against deep venous thrombosis and stress ulcer.
The overall mortality rate of perforation peritonitis ranges from 6% to 36% depending upon the site and cause of perforation. Major causes of post-operative morbidity in such patients are respiratory complications such as pneumonia, atelactasis, pleural effusion. Others are wound infection, septicemia anddyselectrolytemia.
Peritonitis is the inflammation of the peritoneum. It is caused by a bacterial or fungal infection. There are two major types of peritonitis. The common age for its occurrence has been reported to be 45-60 years.
Many of the systemic as well as abdominal manifestations of peritonitis are mediated by cytokines.
Peritonitis presents as an acute abdomen. Abdominal pain is the most important symptom of generalized peritonitis.The examination should focus on the state of intravascular hydration, the presence of shock or multi organ dysfunction and the adequacy of hemodynamic resuscitation.
Investigations which are recommended in patients are complete blood count including platelet count, serum electrolytes, liver and kidney function tests, blood sugar and electrocardiogram.
The objective of pre-operative resuscitation is to rapidly restore adequate oxygen delivery to peripheral tissues. Most patients are hypovolemic from the massive sequestration of fluid into the peritoneum and into the lumen of gut.
Hemodynamic resuscitation, the use of appropriate antibiotics and correction of any abnormalities are essential pre-operative items.
Surgical therapy alone may be sufficient to cure otherwise healthy young patients who have no signs of severe sepsis, hence should never be delayed unnecessarily.
The primary goal of anesthesiologist during the intra operative period is to provide safe and optimal care. General anesthesia with endotracheal intubation and controlled ventilation is the technique of choice.
In all critically ill patients, analgesia, sedation and mechanical ventilation are maintained at the conclusion of surgery. Safe transportation of the patient to the ICU and elaborate handover should also be ensured.
In ICU, Cardio-respiratory support is necessary. Antimicrobialtherapy should be continued.Intravenous hydrocortisone may be considered.
Nutrition is one of the corner stones of management in these patients and adequate glycemic control is important.
Other therapies may be needed, e.g. renal replacement therapy as well as prophylaxis against deep venous thrombosis and stress ulcer.
The overall mortality rate of perforation peritonitis ranges from 6% to 36% depending upon the site and cause of perforation. Major causes of post-operative morbidity in such patients are respiratory complications such as pneumonia, atelactasis, pleural effusion. Others are wound infection, septicemia anddyselectrolytemia.
Other data
| Title | Peri-operative Anesthetic Management for Patients with Perforation Peritonitis | Other Titles | المعالجة التخديرية لمرضى التهاب الغشاء البريتونى نتيجة لثقب الأحشاء وذلك قبل وأثناء وبعد الجراحة | Authors | Mohammed Mohammed EL metwally | Issue Date | 2015 |
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