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HIV and Anaesthesia

HIV and Anaesthesia. M Pearson. Why is it important?. Disease affects all organ systems Drug interactions of HAART risk of infection of personnel. Disease progression. 3 stages; Primary infection with acute seroconversion illness 2–3 weeks after exposure Asymptomatic infection

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HIV and Anaesthesia

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  1. HIV and Anaesthesia M Pearson

  2. Why is it important? Disease affects all organ systems Drug interactions of HAART risk of infection of personnel

  3. Disease progression 3 stages; Primary infection with acute seroconversion illness 2–3 weeks after exposure Asymptomatic infection AIDS with opportunistic infections

  4. CVS effects 50% of pts have abnormal ECHO! Pericardial effusions 25% Endocarditis Dilated cardiomyopathy Ischemic heart disease Pulmonary hypertension 1% Vasculitis with multifocal aneurisms

  5. Pulmonary effects Opportunistic infections Kaposi’s sarcoma Lymphoma Anterior mediastinal mass - compression of trachea, SCV, Heart Oral/pharyngeal lesions with difficult intubation

  6. CNS Dementia Peripheral neuropathy Outonomic neuropathy Raised intracranial pressure Meningitis Focal lesions 35% incidence of polyneuropathy and miopathy

  7. Hematologic Hypercoagulopathy VTE ITP with low platelets Anaemia Bone marrow suppression

  8. GIT Delayed gastric emptying Diarrhea Pancreatitis Hepatic enzymes elevated

  9. Renal Nephropathy Nephrotic syndrome

  10. Endocrine Hyponatremia Hypo/hyper thyroidism Disorders of HPA axis Adrenal insufficiency - most serious complication

  11. Diagnosis Screening: ELISA Confirmation: Western Blot/ RT-PCR CD4 count Viral load

  12. Evolving role of CD4 count Start ARV in all + pts irrespective of CD4 Use viral load to monitor response to ARVs Use CD4 to monitor for PCP, TB and Criptococcus Also low with acute inf, pregnancy, alcohol, steroids, Not an indicator of morbidity and mortality perioperatively

  13. HAART side effects 4 major groups Mitochondrial: lactic acidosis, hepatic toxicity, pancreatitis, neuropathy Metabolic: dyslipidemia, insulin resistance, bone disorders BM supression: anemia, neutropenia, low platelets Allergic reactions.

  14. HAART side effects Zidovidine: BM supression Lamovidine: peripheral neuropathy Tenofivir: Renal toxicity Didanosine: peripheral neuropathy Ritonavir: enzyme inhibition Nevirapine: enzyme induction

  15. HAART and drug interactions

  16. HIV and Anaesthesia No technique is superior GA: drug interactions and multisystem disease RA: peripheral neuropathy/ coagulopathy No significant increase in postop compl Continue HAART steroid supplementation in hemodynamic unstable

  17. GA Preferable drugs that are not dependant on CYP450: Premed: rather Lorasepam Etomidate, Atracurium, Remifentanyl, Desflurane Morphine titrate to response Scoline contra indicated if myopathy

  18. Needle prick injury Risk of transmission 0,31% Recapping biggest risk Post exposure prophylaxis: Ideally within 2 hours Continue 4/52 Use Combivir

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