UPDATES IN ANESTHETIC MANAGEMENT OF SEPTIC SHOCK

Abstract

SUMMARY S EPSIS is a complex syndrome that is difficult to define, diagnose and treat, it is a range of clinical conditions caused by body systemic response to an infection, which if it develops in to severe sepsis, is accompanied by single or multiple organ dysfunction or failure leading to death. When two or more of systemic inflammatory response syndrome criteria are met within evidence of infection, (e.g. pancreatitis). Crush patients may be diagnosed simply with SIRS. Patients with SIRS and acute organ dysfunction may be termed (Severe SIRS).Patients are defined as having (Severe sepsis) if they have sepsis plus signs of systemic hypoperfusion; either end-organ dysfunction or serum lactate greater than 3 mmol per dl. The surgical drainage of abscess cavities, laparotomies, debridement of infected wounds, or amputation of gangerenous limbs may be central to the successful treatment of a patient with severe sepsis. Surgery and anesthesia is often required, even in patients with poor clinical condition. A patient with septic shock initially may present in a classic compensated high cardiac output (CO), low systemic vascular resistance (SVR) state. If this same septic patient’s mechanisms of compensation fails, CO may decrease, SVR may increase, and the patient will no longer exhibit the classic picture diagnosed and treated rapidly before the physician considers other causes of shock. The time taken to improve a patient condition before surgery must be balanced against the urgency to surgically treat the underlying problems. Recent studies have shown the outcome from surgery in these high risk patients is improved if the patient condition is optimized preoperatively. When surgery can be delayed (even for a few hours), attempts should be made to resuscitate the patient to insure adequate oxygen delivery, cardiac output, and blood pressure. This is easiest done in theatre, recovery, or ICU. In a few patients immediate surgery is lifesaving and should be carried out as soon as practical. In these patients preparation time is limited, but initial resuscitation (airway, breathing, and circulation) should be completed during anesthesia. Goals of early resuscitation in patients with sepsis include restoration of tissue perfusion and normalization of cellular metabolism. When appropriate fluid administration fails to restore adequate tissue perfusion and arterial pressure, vasopressors are usually necessary to increase mean systemic pressure, cardiac output, and oxygen delivery Broad spectrum antibiotics, removal or drainage of infected foci, treatment of complications, and pharmacologic interventions to prevent further harmful host responses.