The clinical and post-operative shock: the nature of issue and legal projection

The problem of shock remains to be one of the most complex phenomena in modern medicine. Despite the large number of studies carried out in this field over the past decade, the understanding of the pathogenesis of traumatic shock and the approaches to their prevention and treatment remain to be quite controversial. This greatly complicates the presentation of the issues relating to the operational and post-operative shock. Thus, first of all, we need to answer the question why the terms ‘operational shock’ and ‘post-operative shock’ in recent years are used very rarely.

Following established theory of traumatic shock, its role belongs to the pathogenesis of certain neuro-reflex changes in the body: they are represented in the leading trigger mechanism of shock and is largely determined the subsequent course of the pathological process.

medical negligenceMeanwhile, during and after operations in a perfect anesthetic management indicated pathogenetic factors may not have any significant value, although the development of certain functional disorders is associated with the operation, although their impact can not be ruled out entirely. Since neuro-reflex processes in the pathogenesis of acute threatening conditions during operations and after they are usually not the most crucial, surgeons and anesthetists are not considering legitimate to define these terms as ‘operational shock’ and ‘post-operative shock’. This is where a fine line can be seen, dividing clinical negligence from clinical incidents. According to medical negligence solicitors experts, the average 16-months legal processes stuck on the issue and there were several legal claims already.

But there is another concept, where the use of the term ‘shock’ is aiming at describing any serious condition, characterised by acute development of dangerous circulatory disorders and tissue metabolism, regardless of their causes. This approach helps to understand the meaning of the shock in context of ‘operational shock’ and ‘post-operative shock’, referring to some of the dangers of acute disorders of vital activity during surgery and afterwards. It is mainly all about defining the conditions, characterised by acute hypotension occurred with all of its attendant disorders of blood circulation and metabolism.

operative shockWe have already indicated that the reaction to the injury neuro-reflective reaction now rarely underlie metabolism and circulatory disorders. Modern means and methods of anesthesia for their rational use can prevent or slow down fast reactions to trauma. An example is manifested sometimes with abdominal operations sharp decline in blood pressure in response to stimulation of the most sensitive reflex zones. Such a reaction in some cases, occurs with a seemingly effective general anesthesia on the background of no adverse reactions in connection with the revision of the abdominal cavity, mesentery sipping strong, manipulations on the pancreas, and others.

Often, a lower blood pressure accompanied by slowing heart rate. If the manipulations that cause hypotension are short-term, hemodynamics quickly normalises spontaneously. However, circulatory disorders may be delayed if no appropriate measures are taken. Such measures in these cases are the reflex zones of the blockade by local anesthetics, intravenous administration of an additional dose analgesic and atropine. Normally this is enough to stabilise the hemodynamics. With timely implementation of these measures hypotension is quickly passing, and it seems not to be qualified as an operating shock.