Skip to main content
SpringerLink
Log in

The Patient with Septic Shock

  • Chapter
  • First Online:
Anesthesia in High-Risk Patients

  • 1630 Accesses

Abstract

Septic shock may occur during surgery or may be a cause for emergent surgery. The patients with septic shock in the operating room should be managed according to international guidelines. This implies the use of monitoring to assess the need for fluid, vasopressor, and positive inotrope. The choice of hypnotics remains challenging in those patients with an impaired sympathetic tone. Ketamine seems a reasonable choice for induction, whereas sevoflurane or desflurane can be used for maintenance. Surgery should not be a reason for delaying the administration of antibiotics. Each hour of delay is associated with worsening of outcomes. Sampling blood and secretion are mandatory before the initiation of the antimicrobial treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA. 2016;315:801–10.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Hotchkiss RS, Karl IE. Reevaluation of the role of cellular hypoxia and bioenergetic failure in sepsis. JAMA. 1992;267:1503–10.

    Article  CAS  PubMed  Google Scholar 

  3. Lipiner-Friedman D, Sprung CL, Laterre PF, et al. Adrenal function in sepsis: the Retrospective Corticus Cohort Study. Crit Care Med. 2007;35:1012–8. doi:10.1097/01.CCM.0000259465.92018.6E.

    Article  PubMed  Google Scholar 

  4. Chan CM, Mitchell AL, Shorr AF. Etomidate is associated with mortality and adrenal insufficiency in sepsis. Crit Care Med. 2012;40:2945–53. doi:10.1097/CCM.0b013e31825fec26.

    Article  CAS  PubMed  Google Scholar 

  5. McPhee LC, Badawi O, Fraser GL, et al. Single-dose etomidate is not associated with increased mortality in ICU patients with sepsis. Crit Care Med. 2013;41:774–83. doi:10.1097/CCM.0b013e318274190d.

    Article  CAS  PubMed  Google Scholar 

  6. Alday NJ, Jones GM, Kimmons LA, et al. Effects of etomidate on vasopressor use in patients with sepsis or severe sepsis: a propensity-matched analysis. J Crit Care. 2014;29:517–22. doi:10.1016/j.jcrc.2014.02.002.

    Article  CAS  PubMed  Google Scholar 

  7. Payen J-F, Dupuis C, Trouve-Buisson T, et al. Corticosteroid after etomidate in critically ill patients. Crit Care Med. 2012;40:29–35. doi:10.1097/CCM.0b013e31822d7938.

    Article  CAS  PubMed  Google Scholar 

  8. W-J G, Wang F, Tang L, Liu J-C. Single-dose etomidate does not increase mortality in patients with sepsis: a systematic review and meta-analysis of randomized controlled trials and observational studies. Chest. 2015;147:335–46. doi:10.1378/chest.14-1012.

    Article  Google Scholar 

  9. Li S, Bao H, Han L, Liu L. Effects of propofol on early and late cytokines in lipopolysaccharide-induced septic shock in rats. J Biomed Res. 2010;24:389–94. doi:10.1016/S1674-8301(10)60052-8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Basu S, Mutschler DK, Larsson AO, et al. Propofol (Diprivan-EDTA) counteracts oxidative injury and deterioration of the arterial oxygen tension during experimental septic shock. Resuscitation. 2001;50:341–8. doi:10.1016/S0300-9572(01)00351-3.

    Article  CAS  PubMed  Google Scholar 

  11. ITO T, MISHIMA Y, ITO A, et al. Propofol protects against anandamide-induced injury in human umbilical vein endothelial cells. Kurume Med J. 2011;58:15–20. doi:10.2739/kurumemedj.58.15.

    Article  CAS  PubMed  Google Scholar 

  12. Chiu W-T, Lin Y-L, Chou C-W, Chen R-M. Propofol inhibits lipoteichoic acid-induced iNOS gene expression in macrophages possibly through downregulation of toll-like receptor 2-mediated activation of Raf-MEK1/2-ERK1/2-IKK-NFkappaB. Chem Biol Interact. 2009;181:430–9. doi:10.1016/j.cbi.2009.06.011.

    Article  CAS  PubMed  Google Scholar 

  13. Reich DL, Hossain S, Krol M, et al. Predictors of hypotension after induction of general anesthesia. Anesth Analg. 2005;101:622–8. doi:10.1213/01.ANE.0000175214.38450.91.

    Article  PubMed  Google Scholar 

  14. Zausig YA, Busse H, Lunz D, et al. Cardiac effects of induction agents in the septic rat heart. Crit Care. 2009;13:R144. doi:10.1186/cc8038.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Yu T, Peng X, Liu L, et al. Propofol increases preload dependency in septic shock patients. J Surg Res. 2015;193:849–55. doi:10.1016/j.jss.2014.08.050.

    Article  CAS  PubMed  Google Scholar 

  16. Yu T, Li Q, Liu L, et al. Different effects of propofol and dexmedetomidine on preload dependency in endotoxemic shock with norepinephrine infusion. J Surg Res. 2015;198:185–91. doi:10.1016/j.jss.2015.05.029.

    Article  CAS  PubMed  Google Scholar 

  17. Gelissen HPMM, Epema AH, Henning RH, et al. Inotropic effects of Propofol, thiopental, midazolam, etomidate, and ketamine on isolated human atrial muscle. Anesthesiology. 1996;84:397–403. doi:10.1097/00000542-199602000-00019.

    Article  CAS  PubMed  Google Scholar 

  18. Takaono M, Yogosawa T, Okawa-Takatsuji M, Aotsuka S. Effects of intravenous anesthetics on interleukin (IL)-6 and IL-10 production by lipopolysaccharide-stimulated mononuclear cells from healthy volunteers. Acta Anaesthesiol Scand. 2002;46:176–9. doi:10.1034/j.1399-6576.2002.460209.x.

    Article  CAS  PubMed  Google Scholar 

  19. Hoka S, Takeshita A, Sasaki T, Yoshitake J. Preservation of baroreflex control of vascular resistance under ketamine anesthesia in rats. J Anesth. 1988;2:207–12. doi:10.1007/s0054080020207.

    Article  CAS  PubMed  Google Scholar 

  20. Jabre P, Combes X, Lapostolle F, et al. Etomidate versus ketamine for rapid sequence intubation in acutely ill patients: a multicentre randomised controlled trial. Lancet. 2009;374:293–300. doi:10.1016/S0140-6736(09)60949-1.

    Article  CAS  PubMed  Google Scholar 

  21. Mulvey JM, Qadri AA, Maqsood MA. Earthquake injuries and the use of ketamine for surgical procedures: the Kashmir experience. Anaesth Intensive Care. 2006;34:489–94.

    CAS  PubMed  Google Scholar 

  22. Liu F-L, Chen T-L, Chen R-M. Mechanisms of ketamine-induced immunosuppression. Acta Anaesthesiol Taiwanica. 2012;50:172–7. doi:10.1016/j.aat.2012.12.001.

    Article  Google Scholar 

  23. Taniguchi T, Kidani Y, Kanakura H, et al. Effects of dexmedetomidine on mortality rate and inflammatory responses to endotoxin-induced shock in rats. Crit Care Med. 2004;32:1322–6. doi:10.1097/01.CCM.0000128579.84228.2A.

    Article  CAS  PubMed  Google Scholar 

  24. Penna GL, Fialho FM, Kurtz P, et al. Changing sedative infusion from propofol to midazolam improves sublingual microcirculatory perfusion in patients with septic shock. J Crit Care. 2013;28:825–31. doi:10.1016/j.jcrc.2013.03.012.

    Article  CAS  PubMed  Google Scholar 

  25. Kato R, Foëx P. La protection myocardique contre les lésions d’ischémie-reperfusion par des anesthésiques: Une mise à jour pour les anesthésiologistes. Can J Anaesth. 2002;49:777–91. doi:10.1007/BF03017409.

    Article  PubMed  Google Scholar 

  26. Herrmann IK, Castellon M, Schwartz DE, et al. Volatile anesthetics improve survival after Cecal ligation and puncture. Anesthesiology. 2013;119:901–6. doi:10.1097/ALN.0b013e3182a2a38c.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Punjasawadwong Y, Phongchiewboon A, Bunchungmongkol N. Bispectral index for improving anaesthetic delivery and postoperative recovery. Cochrane Database Syst Rev. 2014;(6):CD003843. doi:10.1002/14651858.CD003843.pub3.

  28. Bilgili B, Montoya JC, Layon AJ, et al. Utilizing bi-spectral index (BIS) for the monitoring of sedated adult ICU patients: a systematic review. Minerva Anestesiol. 2016;83(3):288–301.

    PubMed  Google Scholar 

  29. Murray MJ, DeBlock H, Erstad B, et al. Clinical practice guidelines for sustained neuromuscular blockade in the adult critically ill patient. Crit Care Med. 2016;44:2079–103.

    Article  CAS  PubMed  Google Scholar 

  30. Liu X, Kruger PS, Weiss M, Roberts MS. The pharmacokinetics and pharmacodynamics of cisatracurium in critically ill patients with severe sepsis. Br J Clin Pharmacol. 2012;73:741–9. doi:10.1111/j.1365-2125.2011.04149.x.

    Article  CAS  PubMed  Google Scholar 

  31. Boyd JH, Forbes J, Nakada T-A, et al. Fluid resuscitation in septic shock: a positive fluid balance and elevated central venous pressure are associated with increased mortality. Crit Care Med. 2011;39:259–65. doi:10.1097/CCM.0b013e3181feeb15.

    Article  PubMed  Google Scholar 

  32. Bentzer P, Griesdale DE, Boyd J, et al. Will this hemodynamically unstable patient respond to a bolus of intravenous fluids? JAMA. 2016;316:1298–309. doi:10.1001/jama.2016.12310.

    Article  PubMed  Google Scholar 

  33. Cecconi M, De Backer D, Antonelli M, et al. Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine. Intensive Care Med. 2014;40:1795–815. doi:10.1007/s00134-014-3525-z.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Cannesson M, Le Manach Y, Hofer CK, et al. Assessing the diagnostic accuracy of pulse pressure variations for the prediction of fluid responsiveness: a “gray zone” approach. Anesthesiology. 2011;115:231–41. doi:10.1097/ALN.0b013e318225b80a.

    Article  PubMed  Google Scholar 

  35. Sangkum L, Liu GL, Yu L, et al. Minimally invasive or noninvasive cardiac output measurement: an update. J Anesth. 2016;30:461–80. doi:10.1007/s00540-016-2154-9.

    Article  PubMed  Google Scholar 

  36. Dellinger RP, Levy MM, Rhodes A, et al. Surviving sepsis campaign: international guidelines for Management of Severe Sepsis and Septic Shock, 2012. Intensive Care Med. 2013;39:165–228. doi:10.1007/s00134-012-2769-8.

    Article  CAS  PubMed  Google Scholar 

  37. Stover JF, Stocker R, Lenherr R, et al. Noninvasive cardiac output and blood pressure monitoring cannot replace an invasive monitoring system in critically ill patients. BMC Anesthesiol. 2009;9:6. doi:10.1186/1471-2253-9-6.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Connors AFJ, Speroff T, Dawson NV, et al. The effectiveness of right heart catheterization in the initial care of critically ill patients. SUPPORT Investigators. JAMA. 1996;276:889–97.

    Article  PubMed  Google Scholar 

  39. Akaishi M, Asanuma T, Izumi C, et al. Guidelines for conducting transesophageal echocardiography (TEE): task force for guidelines for conducting TEE: November 15, 2015. J Echocardiogr. 2016;14:47–8. doi:10.1007/s12574-016-0281-9.

    Article  PubMed  Google Scholar 

  40. Jansen TC, van Bommel J, Schoonderbeek FJ, et al. Early lactate-guided therapy in intensive care unit patients: a multicenter, open-label, randomized controlled trial. Am J Respir Crit Care Med. 2010;182:752–61. doi:10.1164/rccm.200912-1918OC.

    Article  PubMed  Google Scholar 

  41. Pope JV, Jones AE, Gaieski DF, et al. Multicenter study of central venous oxygen saturation (ScvO2) as a predictor of mortality in patients with sepsis. Ann Emerg Med. 2010;55:40–46.e1. doi:10.1016/j.annemergmed.2009.08.014.

    Article  PubMed  Google Scholar 

  42. Bakker J, Vincent J-L, Gris P, et al. Veno-arterial carbon dioxide gradient in human septic shock. Chest. 1992;101:509–15. doi:10.1378/chest.101.2.509.

    Article  CAS  PubMed  Google Scholar 

  43. Asfar P, Meziani F, Hamel J-F, et al. High versus low blood-pressure target in patients with septic shock. N Engl J Med. 2014;370:1583–93. doi:10.1056/NEJMoa1312173.

    Article  CAS  PubMed  Google Scholar 

  44. Mahler SA, Conrad SA, Wang H, Arnold TC. Resuscitation with balanced electrolyte solution prevents hyperchloremic metabolic acidosis in patients with diabetic ketoacidosis. Am J Emerg Med. 2011;29:670–4. doi:10.1016/j.ajem.2010.02.004.

    Article  PubMed  Google Scholar 

  45. Perner A, Haase N, Guttormsen AB, et al. Hydroxyethyl starch 130/0.42 versus Ringer’s acetate in severe sepsis. N Engl J Med. 2012;367:124–34. doi:10.1056/NEJMoa1204242.

    Article  CAS  PubMed  Google Scholar 

  46. Albanèse J, Leone M, Delmas A, Martin C. Terlipressin or norepinephrine in hyperdynamic septic shock: a prospective, randomized study. Crit Care Med. 2005;33:1897–902.

    Article  PubMed  Google Scholar 

  47. Leone M, Bourgoin A, Cambon S, et al. Empirical antimicrobial therapy of septic shock patients: adequacy and impact on the outcome. Crit Care Med. 2003;31:462–7. doi:10.1097/01.CCM.0000050298.59549.4A.

    Article  CAS  PubMed  Google Scholar 

  48. Ferrer R, Artigas A, Suarez D, et al. Effectiveness of treatments for severe sepsis. Am J Respir Crit Care Med. 2009;180:861–6. doi:10.1164/rccm.200812-1912OC.

    Article  CAS  PubMed  Google Scholar 

  49. Magiorakos AP, Srinivasan A, Carey RB, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2012;18:268–81. doi:10.1111/j.1469-0691.2011.03570.x.

    Article  CAS  PubMed  Google Scholar 

  50. Solomkin JS, Mazuski JE, Bradley JS, et al. Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Surg Infect. 2010;11:79–109. doi:10.1089/sur.2009.9930.

    Article  Google Scholar 

  51. Sartelli M, Weber DG, Ruppé E, et al. Antimicrobials: a global alliance for optimizing their rational use in intra-abdominal infections (AGORA). World J Emerg Surg. 2016;11:33. doi:10.1186/s13017-016-0089-y.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Montravers P, Dupont H, Gauzit R, et al. Candida as a risk factor for mortality in peritonitis. Crit Care Med. 2006;34:646–52. doi:10.1097/01.CCM.0000201889.39443.D2.

    Article  PubMed  Google Scholar 

  53. Cornely OA, Bassetti M, Calandra T, et al. ESCMID* *this guideline was presented in part at ECCMID 2011. European Society for Clinical Microbiology and Infectious Diseases. Guideline for the diagnosis and management of Candida diseases 2012: non-neutropenic adult patients. Clin Microbiol Infect. 2012;18:19–37. doi:10.1111/1469-0691.12039.

    Article  CAS  PubMed  Google Scholar 

  54. Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis. 2014;59:e10–52. doi:10.1093/cid/ciu296.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Aix Marseille Université, Service d’Anesthésie et de Réanimation, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, APHM, Chemin des Bourrely, 13015, Marseille, France

    Bruno Pastene, Gary Duclos & Marc Leone

Authors
  1. Bruno Pastene
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gary Duclos
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marc Leone
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marc Leone .

Editor information

Editors and Affiliations

  1. Department of Anaesthesiology and Critical Care Medicine, Louis Pradel Hosp, Hospices Civils Lyon, Lyon, Rhône, France

    Jean-Luc Fellahi

  2. Service d'Anesthésie-Réanimation, Hôpital Nord, Marseille cedex 20, France

    Marc Leone

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG

About this chapter

Cite this chapter

Pastene, B., Duclos, G., Leone, M. (2018). The Patient with Septic Shock. In: Fellahi, JL., Leone, M. (eds) Anesthesia in High-Risk Patients. Springer, Cham. https://doi.org/10.1007/978-3-319-60804-4_16

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-60804-4_16

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-60803-7

  • Online ISBN: 978-3-319-60804-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation