SEPTIC SHOCK

Purpose: Many patients with sepsis require surgery for this management , often on an urgent or emergency basis. Anaesthetists are commonly re quired to manage patients with sepsis and septic shock in the operatin g room post anaesthesia recovery area, and the intensive care unit. Si nce little has been written in the Anaesthesia literature on sepsis an d septic shock, a review of this topic was considered appropriate. Sou rce: References were obtained from computerized searches of the Nation al Library of Medicine (English language), recent review articles and personal files. Principle Findings: Septic shock is a common cause of morbidity and mortality. Its presentation may be subtle or catastrophi c. Successful management depends on an understanding of the pathophysi ology of the syndrome, allowing rapid, appropriate resuscitation. This often requires aggressive correction of volume deficit, maintenance o f adequate prefusion pressure with inotropic and vasopressor therapy, mechanical ventilation and correction of coagulopathy. Appropriate cul tures must be taken and antibiotic therapy started, often empirically. Anaesthetic management should include careful haemodynamic monitoring . Anaesthesia induction and maintenance must be tailored to the haemod ynamically unstable patient. Conclusions: The management of the septic patient in the perioperative period presents a challenge for the anae sthetist. Haemodynamic and respiratory instability should be anticipat ed. Management requires multisystem intervention and careful anaesthet ic management.