Anesthetics considerations in peritonitis

Abstract

Peritonitis remains an illness with a significant mortality rate in surgery. Age, male sex, and the inability to control the source are associated with greater mortality. Anesthesia and perioperative medicine should aim to stop the increase in metabolic debt in the pre-surgical phase and to provide metabolic steering during surgery. Early goal directed therapy (EGDT) is still the mandatory cornerstone of management, presented here in several different versions, depending on the monitoring system available in the local clinical environment. The discharge from the operating room to a proper clinical setting must be based on a suitable scoring system, such as APACHE II (acute physiology and chronic health evaluation). Clinical surveillance, when the patient is on the ward, has to be governed for a period using a nursing score like the modified early warning score. Antimicrobial therapy, as well as appropriate timing of administration is both important. Analgesia, locoregional whenever possible, is also an important tool for preventing complications, which occur mainly during the postoperative period, and most frequently in the first month.