INCIDENCE AND MANAGEMENT OF INTRAOPERATIVE HEMODYNAMIC CHANGES DURING PERFORATED LAPAROTOMY PATIENTS
DOI:
https://doi.org/10.5281/zenodo.21836298Keywords:
Perforated laparotomy, hemodynamic instability and hypotension, anesthesia, sepsis, vasopressors, post-operative outcomesAbstract
Introduction: Perforated laparotomy is a potentially dangerous emergency operation that is usually linked to a significant level of physiological unstable conditions sepsis, hypovolemia and metabolic imbalance. These environments precondition patients to severe intraoperative hemodynamic instability, especially hypotension, which may have detrimental effects on organ perfusion and the outcomes after surgery. Perioperative management is thus very critical to minimise the morbidity and mortality.
Methodology: It was a prospective study, observational study involving 120 adult patients (ASA II to ASA III) undergoing emergency perforated laparotomy in a tertiary care hospital. The structured proforma was used to gather data during 4-6 months. Variables were demographics, clinical status, anesthetic care, intraoperative hemodynamic variables, care strategy, and postoperative outcome. The statistical analysis was done through the SPSS version 26. Descriptive statistics, correlation, ANOVA, regression analysis, and independent sample t-tests were used and the level of significance was set to p < 0.05.
Findings: The findings indicated that incidence of intraoperative hypotension was high among the patients especially during peritoneal lavage and post-intubation. Hemodynamic instability was found to be strongly associated with sepsis. Anesthetic agent selection had a profound influence on outcome with ketamine and etomidate showing superior results in cardiovascular-stability over propofol and thiopentone. Fluid therapy was not adequate to provide hemodynamic stability and the application of vasopressors was necessary in a high percentage of cases. There were observed significant correlations among clinical condition, intraoperative hemodynamics, management strategies and patient outcomes.
Conclusion: Intraoperative hemodynamic instability is very common in patients undergoing perforated laparotomy and, it depends on various factors, such as sepsis, anesthetics treatment and interventions during operation. The percent to punctuate patient outcomes with early diagnosis, effective choice of anesthetics, goal-oriented fluid therapy, and early initiation of vasopressors.
