Tamariz CO, Ramírez VI, Rangel FS, Gaona C, García PML, López RM

Language: Spanish
References: 18
Page: 94-101
PDF size: 87.00 Kb.

ABSTRACT

Objetive: To evaluate if a certain anesthetic technique modifies the course of the septic disease, if a certain manipulation confers either protection or increment in mortality and if there is a certain clinical sign predicting severe sepsis. Material and Methods: Patients with two or more criteria of inflammatory response syndrome (SRIS) and one positive blood or tissue culture were included; patients with a negative blood culture and with an unspecified anesthetic technique were excluded. Categorical variables were analyzed using chi square of exact Fisher’s test. Comparisons between groups were analyzed using non paired «t» test and for the correlation of continuous variables Kruskal - Wallis. Results: 1,212 clinical records were analyzed and 177 were included. No deaths were observed in those patients showing 2 symptoms; death was observed in patients showing 3 and 4 symptoms and the number of patients was 3 and 11 respectively. Patients were subdivided according anesthetic technique as follows: Intravenous anesthesia (n=52); Balanced Anesthesia (n=72) and Regional or Mixed (simultaneous regional and intravenous or inhaled anesthesia) (n=48). The group of mixed or regional anesthesia showed a fewer number of SRIS components than the other two groups (p=0.00001). The total length of hospital stay (p=0.0001), the total number of patients accessing the intensive care unit and the length of stay in it were significantly higher in patients receiving general or intravenous anesthesia than those receiving regional or mixed anesthesia (p=0.015). Patients receiving intravenous anesthesia showed a significantly higher mortality than the other groups (p=0.033). Conclusions: The anesthetic technique might have minimal influence on the course of sepsis and we did not observed infectious complications associated to the use of mixed or regional anesthesia. Nevertheless, it is very likely that an early and aggressive hemodynamic management has a positive impact on survival. The results highly suggest that high respiratory rate (tachipnea) might be a marker of severity of the disease an it’s specific weight must be evaluated in prospective surveys.

REFERENCES

1. Wenzel RP. Anti-endotoxin monoclonal antibodies: a second look. N Engl J Med 1992; 20: 864-75.

2. Bone RC. Sepsis, the sepsis syndrome, multiorgan failure: a plea for comparable definitions. Ann Int Med 1991; 114: 332-333.

3. American College of Chest Physicians-Society of Critical Care Medicine Consensus Conference. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 1992; 20: 864-875.

4. Rangel-Frausto S, Pittet D, Costigan M, Hwang T, Davis C, Wenzel RP. The Natural History of the Systemic Inflammatory Response Syndrome (SIRS). A Prospective Study. JAMA 1995; 273: 117-123.

5. Salvo I, De Cian W, Mussico M, Langer M, Piadena R, Wolfer A, et. al. The Italian SEPSIS study: preliminary results on the incidence and evolution of SIRS, sepsis, severe sepsis and septic shock. Int Care Med 1995; S244-S249.

6. Lundberg JS, Perl TM, Wiblin T, Costigan MD, Dawson J, Nettleman MD, Wenzel RP. Septic Shock: an analysis of outcomes for patients with onset on hospital wards versus intensive care units. Crit Care Med 1998; Jun: 1020-1024.

7. Muckart DJ, Bhagwanjee S. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference definitions of the systemic inflammatory reponse syndrome and allied disorders in relation to critically injured patients. Crit Care Med 1997; 25: 1789-95.

8. Jones GR, Lowes JA. The systemic inflammatory response syndrome as a predictor of bacteremia and outcome from sepsis. QJM 1996; 89: 515-19.

9. Rangel-Frausto S, Pittet D, Hwang T, Woolson RF, Wenzel RP. The dynamics of disease progression in sepsis: Markov Modeling describing the natural history and the likely impact of effective Antisepsis Agents. Clin Infect Dis 1998; 27: 185-90.

10. Ueno S, Tanabe G, Yamada H, Kusano C, Yoshidome S, Nuruki K, Yamamoto S, Aikou T. Response of patients with cirrhosis who have undergone partial hepatectomy to treatment aimed at achieving supranormal oxygen delivery and consumption. Surgery 1998; 123: 278-286.

11. Shoemaker WC, Appel PL, Kram HB. Hemodynamic and oxygen transport effects of dobutamine in critically all general surgical patients. Crit Care Med 1986; 14: 1032-1037.

12. Guest JF, Boyd O, Hart WM, Grounds RM, Bennet ED. A cost analysis of a treatment policy of a deliberate perioeprative increase in oxygen deliverty in high risk surgical patients. Int Care Med 1997; 23: 85-90.

13. Suan C, Pérez-Torrez C, Herrera A. Postoperative mortality in a General Hospital. Rev Esp Anestesiol Reanim 1997; 44: 267-272.

14. Heller A, Blecken S, Urbaschek R, Koch T. Effects of intravenous anesthetics on bacterial elimination in human blood in vitro. Acta Anesth Scand 1998; 42: 518-526.

15. Imai T, Takahashi K, Masuo F, Goto F. Anaesthesia affects outcome of sepsis in mice. Can J Anaesth 1998; 45: 360-366.

16. Jomura K, Hamada T, Sugiki K, Ito Y. Epidural anesthesia reduces mortality rate in the patients after emergency abdominal surgery. Masui 1997; 46: 1602-1608.

17. Cohen MM, Duncan PG, Pope WD, Biehl D, Tweed WA, Mac William L, Merchant RN. The Canadian four centre study of anaesthetic outcomes: II. Can outcomes be used to asses the quality of anaesthesia care? Can J Anaesth 1992; 39: 430-439.

18. Quartin AA, Schein RM, Kett DH, Peduzzi PN. Magnitude and duration of the effect of sepsis on survival. JAMA 1997; 277: 1058-1063.