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
