REGIONAL ANESTHESIA IN

ACUTE TRAUMA PATIENT AND

MANAGEMENT OF SEPSIS

ARIZKA MARDIYA EMHA

H1A015008
 INTRODUCTION

 An abnormality of circulatory system that results in

inadequate organ perfusion and tissue oxygenation
 Multiple approaches are necessary in the treatment
of sepsis and shock.
 It is important to select patients for each given
therapy with great care, because the efficacy of
treatment — as well as the likelihood and type of
adverse results — will vary, depending on the
patient.
 REGIONAL ANESTHESIA

 Regional anesthesia is anesthesia affecting only a

specific area of the body when the patient is
conscious, e.g. foot, arm, lower extremities, insensate
to stimulus of surgery or other instrumentation.
 Neuroaxial Block

 Spinal, epidural, and caudal blocks are also known as

neuraxial anesthesia. Almost all operations below
the neck can be performed under neuraxial
anesthesia. However, because intrathoracic, upper
abdominal, and laparoscopic operations can
significantly impair ventilation, general anesthesia
with endotracheal intubation is also necessary.
 SEPTIC SHOCK

 Bacteremia - Presence of bacteria in blood, as

evidenced by positive blood cultures.
 Septicemia - Presence of microbes or their toxins in
blood.
 Systemic Inflammatory Response syndrome(SIRS) -
Two or more of the following conditions: – (1) fever
(oral temperature >38C) or hypothermia (24
breaths/min); – (3) tachycardia (heart rate > 90
beats/min); – (4) leukocytosis (>12,000/L),
leukopenia (
 Sepsis - SIRS that has a proven or suspected
microbial etiology.
 Severe sepsis (similar to“sepsis syndrome”) Sepsis
with one or more signs of organ dysfunction—for
example:
1. Cardiovascular: Arterial systolic blood pressure ≤ 90
mmHg or mean arterial pressure ≤ 70 mmHg that
responds to administration of intravenous fluid
2. Renal: Urine output < 0.5 mL/kg per hour for 1 h
despite adequate fluid resuscitation
3. Respiratory: PaO₂ /FIO₂ ≤ 250 or, if the lung is the
only dysfunctional organ, ≤ 200
4. Hematologic: Platelet count < 80,000/L or 50%
decrease in platelet count from highest value
recorded over previous 3 days
5. Unexplained metabolic acidosis: A pH ≤ 7.30 or a
base deficit ≥ 5.0 mEq/L and a plasma lactate level >
1.5 times upper limit of normal for reporting lab.
 Septic shock - Sepsis with hypotension (arterial
blood pressure < 90 mmHg systolic, or 40 mmHg
less than patient’s normal blood pressure) for at least
1 h despite adequate fluid resuscitation; Or Need for
vasopressors to maintain systolic blood pressure ≥
90 mmHg or mean arterial pressure ≥ 70 mmHg
 MANAGEMENT OF SEPSIS

 cornerstone of emergency management of sepsis is

early, goal-directed therapy, plus lung-protective
ventilation, broad-spectrum antibiotics.
 Early, Goal-directed Therapy

 decreased mortality at 28 and 60 days as well as the

duration of hospitalization.
 mechanisms of the benefit of EGDT are unknown
but may include reversal of tissue hypoxia and a
decrease in inflammation and coagulation defects.
 REFERRENCES

 Gadsden, J. dan Warlick, A. Regional Anesthesia for The Trauma Patient: Improving Patient Outcomes. Local
and Regional Anesthesia. 2015:8:45–55.
 Slade, I.,R., dan Samet, R.,E. Regional Anesthesia and Analgesia for Acute Trauma Patients. Anesthesiology
Clin. 2018:36(3):431-454
 Sengupta Sohini dan Shirley Peter. Trauma Anaesthesia and Critical Care: The Post Trauma Network Era.
Education in Anaesthesia Critical Care & Pain. 2014:14(1):32-37
 Singer, M., et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA.
2016 315(8): 801–810
 Eissa, D., Carton, E.G., dan Buggy, D.J. Anaesthetic Management of Patients with Severe Sepsis. British
Journal of Anaesthesia 2010:105(6): 734–74
 A. R. Plunkett, D. S. Brown, J. M. Rogers, and C. C. Buckenmaier. Supraclavicular continuous peripheral nerve
block in a wounded soldier: when ultrasound is the only option. British Journal of Anaesthesia, 2006 ; 97 :
715–7.
 R. J. Malchow and I. H. Black. The evolution of pain management in the critically ill trauma patient: emerging
concepts from the global war on terrorism. Critical Care Medicine, 2008 ; 36 : 346–57.
 E. M. Davidson, Y. Ginosar, and A. Avidan. Pain management and regional anaesthesia in the trauma patient.
Current Opinion in Anaesthesiology, 2005 ; 18 : 169–74.
 N. B. Foss, B. B. Kristensen, M. Bundgaard et al. Fascia iliaca compartment blockade for acute pain control in
hip fracture patients: a randomized, placebo-controlled trial. Anesthesiology, 2007 ; 106 : 773–8.
 B. D. O'Donnell, H. Ryan, O. O'Sullivan, and G. Iohom. Ultrasoundguided axillary brachial plexus block with
20 milliliters local anesthetic mixture versus general anesthesia for upper limb trauma surgery: an observer-
blinded, prospective, randomized, controlled trial. Anesthesia and Analgesia, 2009 ; 109: 279–83.
THANK YOU 