Abstract
Purpose
Many patients with sepsis require surgery for their management, often on an urgent or emergency basis. Anaesthetists are commonly required to manage patients with sepsis and septic shock in the operating room, post anaesthesia recovery area, and the intensive care unit. Since little has been wntten in the Anaesthesia literature on sepsis and septic shock, a review of this topic was considered appropriate.
Source
References were obtained from computerized searches of the National Library of Medicine (English language), recent review articles and personal files.
Principle Findings
Septic shock is a common cause of morbidity and mortality. Its presentation may be subtle or catastrophic. Successful management depends on an understanding of the pathophysiology of the syndrome, allowing rapid, appropriate resuscitation. This often requires aggressive correction of volume deficit maintenance of adequate perfusion pressure with inotropic and vasopressor therapy, mechanical ventilation and correction of coagulopathy. Appropriate cultures must be taken and antibiotic therapy started, often empirically. Anaesthetic management should include careful haemodynamic monitoring. Anaesthesia induction and maintenance must be tailored to the haemodynamically unstable patient.
Conclusions
The management of the septic patient in the perioperative period presents a challenge for the anaesthetist. Haemodynamic and respiratory instability should be anticipated. Management requires multisystem intervention and careful anaesthetic management.
Résumé
Objectif
Létat septique entraîne souvent des interventions chirurgicales dont quelques-unes sont urgentes. On fait fréquemment appel aux anesthésistes pour la prise en charge de l’état ou du choc septique à la salle d’opération, à l’unité des soins postanesthésiques et aux soins intensifs. Comme la littérature anesthésique mentionne rarement l’état ou le choc septique, il semble pertinent de revoir ce sujet.
Sources
Les références ont été obtenues par recherches informatisée de la National Library of Medicine(en langue anglaise), des articles de revue récents et à partir de dossiers personnels.
Principales constatations
Le choc septique est une cause fréquente de morbidité et de mortalité. II peut survenir subrepticement ou dramatiquement. Sa prise en charge efficace nécessite la compréhension de la physiopathologie de ce syndrome, ce qui permet une réanimation rapide et adéquate. II faut restaurer le volume sanguin agressivement, maintenir une pression de perfusion adéquate, administrer des inotropes et des vasopresseurs. II faut aussi effectuer des cultures et administrer des antibiotiques quelquefois empiriquement. Lanesthésie doit comporter un monitoring hémodynamique minutieux. Linduction et le maintien de l’anesthésie doivent être adaptés à la gravité de l’instabilité hémodynamique du patient.
Conclusion
La gestion du patient septique à la période périopératoire présente un défi pour l’anesthésiste. L’instabilité hémodynamique et respiratoire devrait être anticipée. Le traitement nécessite une intervention sur plusieurs systèmes et une gestion anesthésique appropriée.
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Baxter, F. Septic Shock. Can J Anesth 44, 59–72 (1997). https://doi.org/10.1007/BF03014326
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DOI: https://doi.org/10.1007/BF03014326