THE ROLE OF SHOCK

Emergency laparotomy requiring perioperative antibiotics is often acco mpanied by shock. Whether the shock is the result of haemorrhage, seps is, cardiac disease, or vasodilatation, it represents a profound metab olic alteration which impairs cellular metabolism, causes immunosuppre ssion, and alters pharmacokinetics. These changes lead to an increased risk of infection, which can be overcome, at least in part, by increa sing the dose and (probably) the duration of perioperative antibiotics .