Anaes · General surgery anaesthesia
Anaesthesia for emergency laparotomy
Also known as Emergency laparotomy · NELA anaesthesia · Emergency abdominal surgery anaesthesia · ELPQuiC bundle
Exam-exhaustive emergency laparotomy anaesthesia: sepsis resuscitation before induction, arterial line and RSI, haemodynamic goals, NELA-style risk discussion, ICU triage, contamination and abdominal compartment risk for ANZCA Final and equivalents.
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Red flags
- Inducing the unresuscitated septic patient is a classic path to PEA arrest.
- No arterial line / no vasopressor drawn before RSI in shock is under-prepared.
- Underestimating full-stomach + difficult physiology equals failed airway under hypoxia.
- Skipping risk discussion and ICU plan for high-predicted-mortality cases is poor care.
- Ignoring rising airway pressures and oliguria after closure — think abdominal compartment.
Meet the patient
A 78-year-old woman arrives with a perforated diverticulum. Her blood pressure is 85/40 after a litre of crystalloid, she is cold and peripherally shut down, and the surgical registrar wants her in theatre now. The exam question is the one that separates the safe consultant from the dangerous registrar: do you push the induction drugs, or do you resuscitate first?[1]
Emergency laparotomy carries substantial 30-day mortality, higher in the elderly and in septic shock, with wide historical inter-hospital variation. NELA and the ELPQuiC care bundle turned this into a named exam domain — not because you must recite audit percentages, but because you must risk-assess, resuscitate, seniorise the care, and disposition the patient correctly.[1][2][3]
References4ShowHide
- [1]Eugene N, Oliver CM, Bassett MG, et al. Development and internal validation of a novel risk adjustment model for adult patients undergoing emergency laparotomy surgery: the National Emergency Laparotomy Audit risk model Br J Anaesth, 2018.PMID 30236236
- [2]Huddart S, Peden CJ, Swart M, et al. Use of a pathway quality improvement care bundle to reduce mortality after emergency laparotomy Br J Surg, 2015.PMID 25384994
- [3]Saunders DI, Murray D, Pichel AC, et al. Variations in mortality after emergency laparotomy: the first report of the UK Emergency Laparotomy Network Br J Anaesth, 2012.PMID 22728205
- [4]Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 Intensive Care Med, 2021.PMID 34599691