Awetahagn Abreha

CHAPTER 44

ANAESTHESIA AND AIDS

Outline: Introduction Tests for AIDS Management of the HIV +ve and AIDS patient presenting for anaesthesia Example of a hospital protocol for health care workers

1

airborne droplets or through contamination of intact mucous membrane is unlikely but is not yet disproved. needle injuries. The viruses attach to the T-lymphocytes (CD4 protein bearing cells) which are responsible for the body’s immune response. This may then be followed by one of two clinical courses: • a period of generalised lymph gland enlargement. This is followed by a period with no symptoms. Pneumocystis carinii pneumonia). contamination of cuts. the human immunodeficiency viruses (or HIV) the two most common of which are HIV 1 and 2. spleen and brain. weight loss. sores and abrasions.Awetahagn Abreha INTRODUCTION Acquired immunodeficiency syndrome (AIDS) is a disease which indicates an underlying cellular immune deficiency. The incubation period is not known and the carrier state may 2 . may be responsible for the spread of AIDS. Clinical picture The natural history of the disease is poorly understood. AIDS is caused by a group of retroviruses. The virus infects the T-lymphocyte cells in all lymphoid tissues of the body such as the peripheral blood. A few weeks after infection.g. diarrhoea. The reduction in numbers of T-lymphocytes results in a significant immuno-suppression leading to a variety of infections during the later stages of the disease. lasting months or years. Kaposi Sarcoma) or unusual infections (e. fever. Apart from sexual transmission. progressing to encephalopathy or • a state of immune deficiency resulting in unusual malignancies (e.g. Transmission by saliva. Transmission The transmission of AIDS is by blood and semen and from mother to child through breast milk. the virus causes an acute illness of short duration similar to glandular fever or 'flu'. lymph nodes.

3 . The following groups of patients have the highest risk of contracting AIDS: Homosexuals and bisexuals IV drug users Haemophiliacs Female sexual partners of men at risk Children of affected mothers Patients of Haitian or Central African origin TESTS FOR AIDS No test is yet available for the antigen or virus. Not all seropositive patients will progress to AIDS. The patient’s respiratory. MANAGEMENT OF THE HIV +ve OR AIDS PATIENT PRESENTING FOR ANAESTHESIA Patients with a positive antibody test and patients with frank AIDS should be managed in the same way. Antibody tests are available for HIV-1 + HIV-2 and antibodies are usually present by 3 months post infection.Awetahagn Abreha last for life. AIDS can be diagnosed by a +ve antibody test and a falling CD4 count along with some clinical conditions characteristic of the disease. It is believed that 4%-19% of sero-positive patients develop AIDS within 5 years. gastro-intestinal and neurological function should be checked. It is important to remember that there will always be a certain percentage of patients who appear negative to the antibody test but who are infected with the virus and have not yet developed the antibody (called false negatives). Some workers also suggest that false positives can be found in patients suffering from other nonHIV debilitating infections and repeat testing is recommended before diagnosis is confirmed. Pre-operative visit There is no risk from casual contact except in patients suffering from frank haemorrhage from any cause.

• Use disposable equipment wherever possible. • Dispose of contaminated sharps into rigid-walled. • Sterilise all other equipment according to the recommended procedure (see Chapter 60). • Contaminated linen should be double bagged. caps. once used. • Wash hands thoroughly with soap and water. gloves. • Avoid contact with blood. • Take great care with inserting intravenous needles to avoid spillage. Consider plastic aprons as well.Awetahagn Abreha All patients should be treated as infection risks and “universal precautions” should be taken perioperatively. urine. puncture resistant containers. gloves. • The personnel in theatre should wear protective gowns. • Use the AIDS barrier nursing techniques for severely affected AIDS patients. • Don’t replace equipment. • Take care to minimise contamination with saliva and blood during intubation and extubation. Put it in a tray kept for the purpose. gowns. eye protection (goggles). e. It is important to note that the AIDS virus attacks the cells of 4 . etc. sputum. on the clean anaesthetic trolley. Use protective covering. boots and goggles. Wear gloves for this procedure.g. to avoid the spread of infection to and from the patient. • Specimens from theatre should be taken out of theatre in a waterproof bag or container with an appropriate warning label. Intra-operative management • Keep equipment to a bare safe minimum. • After contact wash hands thoroughly with soap and water.

This calls for extra caution when spinal anaesthetics are used in AIDS patients. • Follow-up testing should be carried out at 6 weeks. nose and mouth. immunoglobulin. cuts. • Before treatment both patient and worker should have an HIV test. broken skin and splashes in eyes. Remember that even significant exposure only carries a 1:200 risk of infection. About 20% of patients with AIDS develop spinal cord involvement. • If treatment is being given the health care worker should be advised to abstain from or use protection during sexual intercourse for 6 months until confirmation of a negative test. Post-operative care Take the same precautions as for intra-operative management. Depending on the result prophylaxis may not be necessary. Exposure may be with blood or body fluids from needle-stick injury. • Post-exposure prophylaxis should be started as soon as possible ideally within 2 hours of exposure but not after 72 hours. The use of blood and blood products still carries a definite risk. • Worker should be advised that taking anti-retroviral drugs for 1 month further reduces the risk of infection.g. Some products (e. factors VIII and IX) are pretreated in an effort to inactivate the virus. 3 months and 6 months and if negative the worker can be assumed to be 5 . EXAMPLE OF A HOSPITAL PROTOCOL FOR HEALTH CARE WORKERS Should accidental contamination occur the hospital should have a policy for post-exposure prophylaxis for its staff. • Rinse/ wash with water or soap and water. All donors are tested for HIV1 and 2 antibodies.Awetahagn Abreha the central nervous system.

Awetahagn Abreha clear of infection. 6 .

Sign up to vote on this title
UsefulNot useful