Septic Peritonitis

Question 1

What is the primary goal in the case of a septic peritonitis patient?

Answer 1

• provide circulatory support

* maintaining perfusion to vital organs prior to, during and after anesthesia

Question 2

What anesthetic drugs would you use if a septic peritonitis patient has been vomiting?

Answer 2

• Opioids such as methadone or meperidine

* Premedicate with anticholinergic to counter vagal stimulation and bradycardic effect of anesthetic agents

Question 3

Benzodiazepines in septic peritonitis patient

Answer 3

• causes very little cardiovascular depression
• use with caution in patients with hypoalbuminemia
• extremely protein bound

Question 4

Etomidate in septic peritonitis patient

Answer 4

*avoid due to it’s adrenocortical suppression

Question 5

Propofol

Answer 5

• acceptable

* short acting

Question 6

Barbiturates

Answer 6

*unfavourable due to it’s vasodilatory effects

Question 7

Ketamine

Answer 7

• supports maintenance of blood pressure
• has a long duration of action
• reasonable choice

Question 8

Isoflurane or sevoflurane alone

Answer 8

• not a good choice as it can exacerbate hemodynamic instability and will likely lead to clinically significant hypotension
• Opioid, benzodiazepine, ketamine, lidocaine CRIS can lower the MAC of inhalant to reduce the inhalant necessary

Question 9

When do you consider TIVA (propofol, Fentanyl) in a septic peritonitis patient?

Answer 9

Hypotension despite efforts to reduce inhalant anesthetics and concurrent intraoperative fluid volume support.