Challenges and strategies for anesthetic management in patients with septic shock

Guangling Feng¹, Peng Ji², Song Yao², Jinyu Wang², Jie Gao³, Xianling Guo³, Zhui Ke³*

¹ First People’s Hospital of Guiyang, Guiyang City, Guizhou Province, 550000, China  

² Xiangshui County People’s Hospital, Jiangsu, 224600, China  

³ Tenth People’s Hospital Affiliated to Tongji University, Shanghai, 200092, China

Correspondence：

Ke Zhui; Email: kezhui1314@163.com

Abstract

Septic shock is a serious surgical complication with a high mortality rate and presents challenges for anesthetic management. This review examines the pathophysiological mechanisms, perioperative risks, and impact of septic shock on the function of multiple organs, as well as the latest advances and strategies in anesthetic management for surgical patients with septic shock. Remimazolam and ketamine are preferred for anesthetic management of these patients in view of their minimal impact on hemodynamics. Regional anesthesia and nerve block techniques may improve the prognosis in high-risk patients. Rational use of vasopressors, advanced hemodynamic monitoring, and restrictive transfusion strategies are also key elements in management. Agents such as fentanyl, which may exacerbate circulatory suppression, should be avoided, and the risks of general anesthesia in specific populations should be carefully considered. This review provides a systematic and practical clinical reference for young anesthesiologists, emphasizing individualized and multidisciplinary management to improve perioperative outcomes in patients with septic shock.