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Sepsis and shock are severe conditions that, when together, may cause multiple organ failure. The anesthesiologist must be able to take a careful history and physical, as well as be aware that additional tests are necessary to assess the patient status, as preoperative systemic blood pressure is not indicative of adequate volume status. In preparation for surgery, one must anticipate dysfunction and have adequate blood products and antibiotic at hand. Ketamine is notable for induction in these patients because it is less likely to decrease systemic vascular resistance too quickly. One must not take this lightly, as death may ensue if proper management is not taken.

Congestive heart failure (CHF) is increasingly being recognized as a health problem in the United States. It is estimated that the lifetime risk for CHF is 1 in 5. The clinical anesthesiologist can expect to see several cases involving patients suffering from CHF. Because of the danger associated with surgery in a patient with CHF, a thorough knowledge of the disorder and the potential effects on the delivery of anesthetics must be considered. In addition, knowledge of the disease process and its manifestations is required for smooth guidance of the patient through the perioperative period. The understanding of current pharmacotherapies, surgical procedures and their implications related to interactions with anesthetics are all discussed.

MOF or MOSF is a serious condition that represents a leading cause of death in critically ill or injured patients. It commonly begins as a result of injury, widespread inflammation, infection, shock or a combination of the above. Progression from SIRS to MOSD and on to MOF can occur within days. Therefore, careful systemic monitoring of respiratory, cardiovascular central nervous, renal, hepatic, gastrointestinal and hematologic function is vital. Although certain mechanisms such as decreased O2 supply to cells, neutrophil priming, increased TNF-alpha, interleukins, and NO have been implicated, an effective treatment for this condition remains elusive. The anesthesiologist and critical care professionals must work together to effectively evaluate and treat the MOF patient.