Intraoperative Sepsis - Guidelines for Crises in Anaesthesia



Severe sepsis (hypotension persisting after initial fluid challenge of 30ml.kg-1 or blood lactate concentration ≥ 4mmol.l-1 if infection most likely underlying cause) or septic shock (sepsis with end organ dysfunction).



❶ Call for help and inform theatre team of problem.

❷ Increase FiO2, consider reducing anaesthetic agent and intubate patient.

❸ Give crystalloid i.v.:

  • Adult: at least 30 ml.kg-1 (Box A, Box B).

  • Child: at least 20 ml.kg-1 (Box C).

❹ Take bloods including blood gas, lactate, FBC, U&Es, coagulation and cultures.

❺ Give empiric intravenous antimicrobials within 1 h (seek microbiology advice).

❻ Consider whether indwelling devices could have caused a septic shower.

❼ If patient is not improving proceed to the next steps.

❽ Insert central and arterial access lines. Check serial lactates.

❾ Start noradrenaline to achieve mean arterial pressure ≥ 65 mmHg (Box D).

❿ Insert urinary catheter and record hourly urine output.

⓫ Consider monitoring cardiac output to further aid fluid and vasopressor therapy.

⓬ Identify source of sepsis, consider source control and send source cultures if possible (eg. surgical site, urine, broncho-alveolar lavage).

⓭ Discuss whether appropriate to abandon or limit surgery.

⓮ Discuss ongoing management plan with intensive care team.



By Association of Anaesthetists @ https://twitter.com/AAGBI

Quick Reference Handbook - Guidelines for crises in anaesthesia 



#Sepsis #Anesthesiology #Anesthesia #Intraoperative #Checklist #Diagnosis #Management #Workup