Anaes · Perioperative medicine
Sepsis under anaesthesia
Also known as Septic shock induction · Surviving Sepsis Campaign anaesthesia · Emergency laparotomy sepsis · Noradrenaline septic patient
Exam-pass sepsis under anaesthesia: Sepsis-3 framing, SSC hour-1 principles, induction of the septic patient, source control, noradrenaline and MAP targets, lactate interpretation, and ICU handover for ANZCA Final and equivalents.
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Red flags
- Full-dose propofol induction in unresuscitated septic shock is a classic arrest pathway.
- Antibiotics delayed for 'just getting the line' without a plan wastes the golden hour.
- Source control delayed by endless imaging in an unstable patient can be fatal.
- Lactate is a trend tool — not a single magic number that replaces clinical perfusion.
- Handing a still-shocked patient to a dark ward bay is disposition failure.
Meet the patient
A 72-year-old is admitted with a perforated viscus, a blood pressure of 75 over 40, and a lactate of 6 mmol per litre. The surgeon wants to open the abdomen now. Your job is to get this patient to the knife and through it without a PEA arrest on induction — and the three things that decide whether that happens are antibiotics and cultures already given, volume and a pressor drawn before induction, and a source-control clock agreed with the surgeon.[1]
This is the classic "lists and collapse" stem. The examiner wants Sepsis-3 language, Surviving Sepsis Campaign priorities, a safe induction, a noradrenaline and MAP plan, source control, and an intelligent read of lactate and perfusion — not a microbiology seminar.[1]
References4ShowHide
- [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]Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med, 2001.PMID 11794169
- [3]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
- [4]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