Perioperative Sepsis and Septic Shock: An Update

Sepsis and septic shock were described by Hippocrates and had high morbidity and mortality, till Surviving Sepsis Guidelines were published in 2002. Although implementation of these protocols is low, nevertheless it effectively decreased the morbidity and mortality. Daily millions of surgeries are performed all over the world, and the rate of perioperative sepsis and septic shock is increasing. The anesthetist, acute care physician, surgeons, and intensivist should be aware of sepsis and its updates. Sepsis can occur at any age, but extremes of age remain a high risk for developing sepsis in the perioperative period. Emergency and trauma surgeries are at higher risk of developing sepsis in the perioperative period. The surge in proinflammatory cytokines, mitochondrial dysfunction, and disseminated intravascular coagulation are the main components of sepsis pathophysiology. Diagnosis of perioperative sepsis can be made with raised septic markers (C-reactive protein and procalcitonin) and with advanced hemodynamic monitoring. Early diagnosis and proper management are key to improved patient outcomes. The Sepsis Six is a good tool for the initial management of sepsis patients in the ward in the postoperative period. Delays in antimicrobial administration in these patients increase mortality. Proper hydration, organ-supportive care, correction of coagulopathy, hemodynamic support, and renal replacement therapy may be required in these patients. In patients with perioperative sepsis and septic shock, early and bold debridement and source control will have a better patient outcome.