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