In the acute situation, perioperative management should be planned in liaison with the anaesthetic team.
- Intravenous access – in the acute abdomen significant fluid shift will occur, requiring appropriate fluid resuscitation so a large-bore cannula is essential. In some cases central venous access may be required
- Fluids – bowel obstruction or ileus, laparotomy, pyrexia, oral fluid restriction and vomiting contribute to intravascular fluid depletion in the acute abdomen and fluid should be administered to replace these
- Electrolyte balance – vomiting and diarrhoea often contribute to hypokalaemia, with hyperkalaemia occurring after blood transfusion. Electrolytes should be monitored carefully. Poor renal perfusion will also affect clearance of electrolytes and other waste products.
- Bloods – monitor haemoglobin and ensure cross matched blood is available if needed
- Clotting – monitor coagulation where haemorrhage has occurred and ensure availability of platelets and fresh–frozen plasma (FFP) where needed
- Analgesia – epidural, patient controlled analgesia or systemic analgesia are likely to be required
- Arterial blood gas – in cases of metabolic compromise, acid base and hypoxia should be corrected according to blood gas measurements
- Intravenous antibiotics – broad spectrum cover is necessary for all bowel related acute abdominal pathology and in cases where laparotomy is necessary.