Anesthetic management for patients with perforation peritonitis

Abstract

Perforation peritonitis is a common surgical emergency. Anesthesia in patients with perforation peritonitis can be challenging. Delayed presentations, old age, hemodynamic instability, presence of sepsis and organ dysfunction are some of the predictors of poor outcome in such patients. Pre-operative optimization can reduce intraoperative and post-operative morbidity and mortality, but surgery should not be unnecessarily delayed. Intensive care in critical care settings may be essential.

Impact of Soil Cadmium on Land Snails: A Two-Stage Exposure Approach under Semi-Field Conditions Using Bioaccumulative and Conchological End-Points of Exposure

“…The spiking solutions had the following nominal concentrations (1) in the E1 phase: M1, control group; Cd1.1., 25 mg/L cadmium; Cd2.1., 50 mg/L cadmium; Cd3.1., 100 mg/L cadmium; Cd4.1, 125 mg/L cadmium; (2) in the E2 phase: M2, control group; Cd1.2., 50 mg/L cadmium; Cd2.2., 100 mg/L cadmium; Cd3.2., 200 mg/L cadmium; Cd4.2., 250 mg/L cadmium. The exposure route realistically simulated Cd transfer from soils to snails in natural environments, that is as a cumulative process that occurs via mixed dermal (diffusion through the foot epithelium) and digestive routes (ingestion of soil particles and detritus) [ 16 , 18 , 20 ]. For each experimental phase, Cd toxicity was assessed under static exposure conditions (substrate without renewal).…”

“…The kinetics of Cd transfer from soils to land snails has been extensively studied under both laboratory conditions [ 8 , 13 – 17 ] and semi-field conditions [ 18 – 20 ]. Cadmium was measured in the foot and viscera, not in the hepatopancreas although it accumulates primarily and in a dose-dependent manner in this organ [ 6 , 21 ].…”

Short-term effects of very low dose cadmium feeding on copper, manganese and iron homeostasis: A gastropod perspective

“…However, little is known about similar interactions in land snails, despite their importance as major herbivores in terrestrial ecosystems and pertinent bioindicators of environmental contamination (Gerlach et al, 2013). These invertebrates serve as excellent macro-concentrators for cadmium (Dallinger and Rainbow, 1993), with the hepatopancreas being the main retention endpoint (Russel et al, 1981;Rabitsch, 1996;Dallinger et al, 2004;Fritsch et al, 2011;Pauget et al, 2013). Therefore, the concentration of Cd in this organ is a reliable tool for exposure assessment and provides accurate estimates of its bioavailability for these mollusks (Rabitsch, 1996;Nica et al, 2015).…”

Anesthetic management for patients with perforation peritonitis

“…We read with interest a recently published review article by Sharma et al . entitled, “Anesthetic management for patients with perforation peritonitis.”[ 1 ] There are some issues that can affect the anesthesia management and outcome hence need discussion:…”