Anaes SAQs · Perioperative medicine
Sepsis under anaesthesia
Final-examination SAQ for sepsis-under-anaesthesia.
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ANZCAFRCAEDAICABAFCAI
Prompt
A 68-year-old with perforated viscus, BP 80/45 on noradrenaline 0.2 mcg/kg/min, lactate 4.8 mmol/L, is listed for emergency laparotomy. Outline resuscitation, induction, intraoperative, and postoperative plans.
Model answer
Resuscitation (4). SSC priorities: cultures if no delay, early antibiotics, fluid then reassess responsiveness, continue noradrenaline for MAP ~65 mmHg (individualise), serial lactate/perfusion signs.[1][2][3]
Induction (4). Arterial line, reduced-dose RSI, vasopressors running, senior help, expect desaturation/collapse risk.[1]
Intraoperative (3). Maintain MAP/perfusion, facilitate source control, protective ventilation, glucose, avoid nephrotoxins.[1]
Postoperative (4). ICU if still shocked/acidotic; hand over antibiotics time, pressors, lactate trend, surgical plan.[1]
References3ShowHide
- [1]Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Crit Care Med, 2021.PMID 34605781
- [2]Asfar P, Meziani F, Hamel JF, et al. High versus low blood-pressure target in patients with septic shock. N Engl J Med, 2014.PMID 24635770
- [3]Hernández G, Ospina-Tascón GA, Damiani LP, et al. Effect of a Resuscitation Strategy Targeting Peripheral Perfusion Status vs Serum Lactate Levels on 28-Day Mortality Among Patients With Septic Shock: The ANDROMEDA-SHOCK Randomized Clinical Trial. JAMA, 2019.PMID 30772908