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

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: Fluid resuscitation (1500 mL crystalloid, 1000 mL colloid, 500 mL fresh frozen plasma) guided by pulse pressure variation (PPV) / transthoracic echocardiography (TTE) Vasopressors (norepinephrine 0.1–0.3 μg/kg/min + vasopressin 0.01–0.02 U/min) Metabolic correction (sodium bicarbonate for pH 7.246, calcium gluconate for Ca²⁺ 0.87 mmol/L) 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: Early hemodynamic optimization (MAP ≥65–70 mmHg, urine output >0.5 mL/kg/h) Multimodal monitoring (PPV, TTE, etc.) Balanced fluid/vasopressor therapy Metabolic and temperature control This case highlights the critical role of tailored anesthetic strategies in managing this high-mortality condition.