Caparrós-Lledó A, Fernández-Torres B, González LA, García-Cebrián MJ

Language: Spanish
References: 9
Page: 256-260
PDF size: 929.05 Kb.

ABSTRACT

The most frequent causes of emergency laparotomy include perforation, bowel obstruction, and suture dehiscence. Although it is a pathology with high morbidity and mortality, a downward trend has been observed in recent years and the first ERAS (Enhanced Recovery After Surgery) guidelines focused on emergency surgery were published in 2023. We present the case of a patient with a long-standing intestinal obstruction, reaching levels of distension that are difficult to imagine, in whom we manage exclusively anaesthetic aspects based on the ERAS recommendations. However, these guidelines highlight the need to use validated specific scales for the early identification of pathophysiological deterioration, sepsis, surgical risk, fragility, risk of venous thromboembolism, and postoperative delirium. Incorporating these scales is one of the aspects of improvement in our anaesthetic management, as it allows us to improve communication, assign the appropriate level of care, and optimise clinical management.

REFERENCES

1. Parthasarathy S, Sripriya R, Krishnaveni N. Anesthetic management of intestinal obstruction: a postgraduate educational review. Anesth Essays Res. 2016;10:397-401. doi: 10.4103/0259-1162.177192.

2. Peden CJ, Aggarwal G, Aitken RJ, Anderson ID, Bang N, Cooper Z, et al. Guidelines for Perioperative Care for Emergency Laparotomy Enhanced Recovery After Surgery (ERAS) Society Recommendations: Part 1—preoperative: diagnosis, rapid assessment and optimization. World J Surg. 2021;45:1272-1290. doi: 10.1007/s00268-021-05994-9.

3. Scott MJ, Aggarwal G, Aitken RJ, Anderson ID, Balfour A, Foss NB, et al. Consensus Guidelines for Perioperative Care for Emergency Laparotomy Enhanced Recovery After Surgery (ERAS®) Society Recommendations Part 2-Emergency laparotomy: intra- and postoperative care. World J Surg. 2023;47:1850-1880. doi: 10.1007/s00268-023-07020-6.

4. Peden CJ, Aggarwal G, Aitken RJ, Anderson ID, Balfour A, Foss NB, et al. Enhanced Recovery After Surgery (ERAS®) Society Consensus Guidelines for Emergency Laparotomy Part 3: organizational aspects and general considerations for management of the emergency laparotomy patient. World J Surg. 2023;47:1881-1898. doi: 10.1007/s00268-023-07039-9.

5. Aggarwal G, Scott M, Peden CJ. Emergency laparotomy. Anesthesiol Clin. 2022;40:199-211. doi: 10.1016/j.anclin.2021.11.010.

6. El-Orbany M, Connolly LA. Rapid sequence induction and intubation: current controversy. Anesth Analg. 2010;110:1318-1325. doi: 10.1213/ANE.0b013e3181d5ae47.

7. Zdravkovic M, Berger-Estilita J, Sorbello M, Hagberg CA. An international survey about rapid sequence intubation of 10,003 anaesthetists and 16 airway experts. Anaesthesia. 2020;75:313-322. doi: 10.1111/anae.14867.

8. Barazanchi A, Bhat S, Palmer-Neels K, MacFater WS, Xia W, Zeng I, et al. Evaluating and improving current risk prediction tools in emergency laparotomy. J Trauma Acute Care Surg. 2020;89:382-387. doi: 10.1097/TA.0000000000002745.

9. Murphy PB, Vogt KN, Lau BD, Aboagye J, Parry NG, Streiff MB, et al. Venous thromboembolism prevention in emergency general surgery; a review. JAMA Surg. 2018;153(5):479-486. doi: 10.1001/jamasurg.2018.0015.