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Anesthetic Management of Intestinal Ischemic Necrosis Complicated by Septic Shock: A Case Report

Jingxuan Qiu^1*
1Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China

Corresponding Author: Jingxuan Qiu
Address: Department of Anesthesiology, West China Hospital, Sichuan University, 37 Guo Xue St, Chengdu, Sichuan 610041, China.
Received date: 15 July 2025; Accepted date: 28 July 2025; Published date: 04 August 2025

Citation: Qiu J. Anesthetic Management of Intestinal Ischemic Necrosis Complicated by Septic Shock: A Case Report. Asp Biomed Clin Case Rep. 2025 Aug 04;8(2):198-202.

Copyright © 2025 Qiu J. This is an open-access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium provided the original work is properly cited.

Keywords: Intestinal Ischemic Necrosis, Septic Shock, Anesthesia, Hemodynamic Stabilization, Emergency Laparotomy

Abbreviations: PPV: Pulse Pressure Variation; BIS: Bispectral Index; TTE: Transthoracic Echocardiography; ABG: Arterial Blood Gas Analysis; POD: Postoperative Day; ABP: Arterial Blood Pressure; CVP: Central Venous Pressure; SVR: Systemic Vascular Resistance.

Abstract

Intestinal ischemic necrosis is a life-threatening condition caused by compromised intestinal blood flow due to arterial/venous occlusion or vasoconstriction, with acute mesenteric ischemia (60–70% of cases, mortality >60%) and colonic ischemia as primary subtypes. This case report describes the anesthetic management of a 56-year-old male with acute intestinal ischemic necrosis complicated by septic shock, requiring emergent laparotomy. Preoperative assessment revealed hemodynamic instability (HR 130 bpm, BP 85/43 mmHg, SpO₂ 89%) and peritoneal signs.
Anesthesia involved rapid-sequence induction with etomidate/rocuronium and maintenance with sevoflurane–remifentanil under BIS guidance. Hemodynamic stabilization included:

1. 1. Fluid resuscitation (1500 mL crystalloid, 1000 mL colloid, 500 mL fresh frozen plasma) guided by pulse pressure variation (PPV) / transthoracic echocardiography (TTE)

1. 1. Vasopressors (norepinephrine 0.1–0.3 μg/kg/min + vasopressin 0.01–0.02 U/min)

1. 1. Metabolic correction (sodium bicarbonate for pH 7.246, calcium gluconate for Ca²⁺ 0.87 mmol/L)

1. 1. Epinephrine infusion (0.02–0.1 μg/kg/min) improved left ventricular ejection fraction (35% → 45–50%) and right ventricular function

The patient underwent successful small bowel resection (300 cm) with primary anastomosis (operative time: 108 minutes, EBL: 100 mL), was extubated on postoperative day (POD) 3, and discharged on POD 22.
Key anesthetic principles emphasized:

1. 1. Early hemodynamic optimization (MAP ≥65–70 mmHg, urine output >0.5 mL/kg/h)

1. 1. Multimodal monitoring (PPV, TTE, etc.)

1. 1. Balanced fluid/vasopressor therapy

1. 1. Metabolic and temperature control

This case highlights the critical role of tailored anesthetic strategies in managing this high-mortality condition.