Perioperative management of septic peritonitis in small animals: A review

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Perioperative management of septic peritonitis in small animals: A review

Abstract

Background: Septic peritonitis is a complex, life-threatening disease, driven by peritoneal inflammation and microbial contamination, requiring timely and dynamic perioperative management.

Aims: The aim of this review was to synthesize current knowledge on the perioperative management of septic peritonitis in dogs and cats.

Conclusions: Evidence-based strategies for initial stabilization include fluid resuscitation with balanced crystalloids, vasopressors, and antimicrobial therapy targeting polymicrobial infections. Anesthetic management should prioritize hemodynamic stability and a multimodal approach to analgesia. Postoperative management should include early enteral nutrition (which is associated with increased survival) and monitoring and treatment of coagulation derangements. Patients should be closely monitored for recurrent septic peritonitis after surgery, which is associated with high mortality. Evidence for risk factors of dehiscence such as hypoalbuminemia and interoperative hypotension is inconsistently found in studies. Other potential complications include hospital-acquired infection and intra-abdominal hypertension.

Implications: There is significant variation in the treatment approach for small animals with septic peritonitis, likely due to gaps in evidence. Reported survival rates vary widely between studies due to diverse and inconsistent study populations, highlighting the need for further research to optimize care in veterinary patients.

One | INTRODUCTION

The peritoneum lines the abdominal cavity and covers organs and mesenteries. Its cells maintain peritoneal homeostasis, regulating movement of molecules and cells across the peritoneum and keeping inflammatory and immune-mediated processes in check. Insults like trauma (including surgery), inflammation, ischemia, bacteria, and endotoxins stimulate a mesothelial-to-mesenchymal transition. These transformed cells orchestrate a multifaceted set of pro- and anti-inflammatory and immunomodulatory processes designed to restore balance. The complexity of these processes helps one understand how peritonitis can sometimes rapidly progress beyond the point where balance can be restored.

Septic peritonitis is characterized by peritoneal inflammation and microbial contamination. It is associated with high morbidity and mortality, with survival rates even lower for septic peritonitis occurring after surgery for an initial septic peritonitis. Evidence-based perioperative management of septic peritonitis centers on timely restoration of hemodynamic stability, adequate analgesia, empiric broad-spectrum antimicrobials with appropriate de-escalation, early postoperative enteral nutrition, and vigilant postoperative monitoring and intervention for conditions like recurrence of septic peritonitis after surgery for septic peritonitis, hospital-acquired infection, and intra-abdominal hypertension. This review brings together current insights into perioperative therapeutic strategies in septic peritonitis to improve outcome in veterinary patients. Initial diagnosis and intraoperative source-control strategies are addressed in a companion manuscript.

Pertinent papers were collected via a PubMed search for "septic peritonitis," "septic effusion" and "peritonitis" and "Dog" or "Cat" or "Veterinary" from the last fifteen years. Additional sources were identified via "cited by" or "similar articles," from relevant manuscripts, or additional subtopic searches. The authors focused on case series where the study period extended into the last fifteen years.

Two | SEPTIC PERITONITIS CLASSIFICATION

Three | FLUID RESUSCITATION

Four | ANTIMICROBIAL THERAPY

Four point one | Antibacterial drugs

Four point two | Antifungal drugs

Five | ANALGESIA

Six ANESTHESIA

Six point two. Premedication and anesthetic induction

Six point three. Local analgesia

Six point four. Maintenance of anesthesia

Six point five. Management of intraoperative hypotension

Seven. POSTOPERATIVE MANAGEMENT

Seven point one. Nutrition

Seven point two. Thromboprophylaxis

Eight. Complications

Eight point one. Recurrent septic peritonitis

Eight point two. Hospital acquired infection

Eight point three. Intra-abdominal hypertension

Eight point four. Mortality

Nine. Summary

Overview

The document provides an overview of best practices for managing septic peritonitis in small animals, emphasizing the importance of timely intervention and multimodal approaches. It discusses fluid resuscitation, antimicrobial therapy, and the need for vigilant monitoring post-surgery to improve outcomes in veterinary patients.

Key Points

1Septic peritonitis requires dynamic perioperative management to prevent high mortality rates
2Evidence-based strategies include fluid resuscitation, antimicrobial therapy, and hemodynamic stability
3Early enteral nutrition is linked to increased survival rates
4There is significant variation in treatment approaches, highlighting the need for further research
5Postoperative monitoring is critical for detecting complications and recurrent infections

Details

Authors: Shana K. O'Marra, Bonnie G. Campbell
Category: Health and Medicine

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