Expert consensus on the perioperative management of patients with sepsis

Sepsis is defined as an infection associated with systemic manifestations of inflammation, which has become the most common complication in the perioperative period caused by severe burn/trauma and major surgical operation.[1,2] The incidence of sepsis in adults is estimated to be 149–240/100 000 per year, and that of severe sepsis and septic shock is 56–91/100 000 per year. In the last decade, the short-term mortality of sepsis has declined to around 20% in developed countries partly due to the international Surviving Sepsis Campaign (SSC), while the mortality remains very high (50%–80%) in 1–5 years after discharge from hospitals.[3–7] Thus, sepsis and its subsequent severe sepsis and septic shock are currently major issues in the field of medical and health care. Control of infection, involving removal of infected and necrotic tissue, surgical drainage of abscess combined with early antimicrobial therapy, is essential to the successful treatment of sepsis.[8] Imbalance of pro-inflammation and anti-inflammation in septic patients is usually caused by the failure of infection control or the perforation of hollow organs. Fast exacerbation of sepsis constantly leads to circulatory and respiratory insufficiency and/or other viscera damage. Hence the risk of septic patients is very high during anesthesia. To improve the quality of clinical anesthesia and reduce the incidence of perioperative death and organ dysfunction in patients with sepsis, the Chinese Association of Anesthesiologists (CAA) set up a consensus committee consisting of 22 well-known Chinese anesthesiologists to draft a consensus on the perioperative management of patients with sepsis.