Low Complication Rate Associated with Cesarean Section under Spinal Anesthesia for HIV-1–Infected Women on Antiretroviral Therapy

Avidan, Michael S.; Groves, Philippa; Blott, M; Welch, Jan; Leung, Theresa G.; Pozniak, Anton; Davies, E. G.; Ball, Colin; Zuckerman, Mark

doi:10.1097/00000542-200208000-00006

Cited by 65 publications

(41 citation statements)

References 17 publications

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“…The advantage of a regional technique in the HIV-positive parturient has been confirmed. 7,31,32 This is the technique of choice with no increased risk of introducing the disease to the CNS. 33 There is no contraindication to an epidural blood patch if indicated in the HIV-positive patient, although conservative management may be preferred.…”

Section: Anaesthetic Techniquementioning

confidence: 99%

Antiretroviral therapyand anaesthesia

Schulenburg

Roux

2008

Southern African Journal of Anaesthesia and Analgesia

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HIV has reached pandemic proportions in Southern Africa. Great emphasis is placed on the prevention and containment of HIV transmission by suppressing virus replication using highly active anti-retroviral therapy (HAART). HAART has proven to be highly effective if taken correctly, and has lead to increased life expectancy. Increasing numbers of HIV-positive patients on antiretroviral (ARV) therapy or HIV-exposed individuals taking prophylaxis present for surgery and critical care management. The anaesthesiologist should be familiar with the anaesthetic implications of HIV as well as the possible drug interactions while on ARV treatment. This article focuses specifically on the anaesthetic implications of the patient on HAART.HAART is HIV treatment with a combination of three or more ARV drugs from five broad classes. The specific HAART regimen in use in South Africa is considered in detail in this article. The pharmacokinetics of the ARV drugs is complex, and subject to interactions at many different sites. Serious drug interactions are possible, including drugs commonly used in anaesthesia. Drug interactions and recommendations are discussed in detail.ARVs are known to cause multiple systemic side effects, including lactic acidosis, Immune Reconstitution Inflammatory Syndrome (IRIS), premature atherosclerosis and increased cardiovascular risk, hyperlipidaemia, insulin resistance, skeletal disorders, hepatotoxicity, lipodystrophy, mitochondrial abnormalities, allergic reactions and pancreatitis.Non-compliance is common, and leads to the rapid development of resistance. The anaesthesiologist may inadvertently exacerbate this in the perioperative period. Recommendations regarding the interruption of treatment and fasting are made. Alternative routes for HAART administration are also explored. The management of the critically ill patient on a HAART regimen is discussed.

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Section: Anaesthetic Techniquementioning

confidence: 99%

Antiretroviral therapyand anaesthesia

Schulenburg

Roux

2008

Southern African Journal of Anaesthesia and Analgesia

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“…Hughes et al fanden keinen Unterschied im Immunstatus oder der Inzidenz infektiöser oder neurologischer Komplikationen von HIV-positiven Patientinnen nach Peridural-und Spinalanästhesien im Vergleich zu HIV-positiven Patientinnen,die zur schmerzarmen vaginalen Geburt eine intravenöse Analgesie erhalten hatten [18]. Im Rahmen einer HIV-Infektion findet die ZNS-Beteiligung zu einem sehr frü-hen Zeitpunkt statt.Die Vorstellung,HIVViren mechanisch durch die Penetration des Periduralraums in einen bislang virusfreien Liquor cerebrospinalis während einer Spinalanästhesie zu bringen,ist nicht wahrscheinlich [2].…”

Section: Anästhesieverfahrenunclassified

“…Verglichen mit HIV-negativen Schwangeren nach Sectio caesarea fanden Avidan et al eine um einem Tag verlängerte Krankenhausverweildauer (5 Tage vs. 4 Tage) bei HIV-positiven Patientinnen [2].In der vorliegenden,nichtvergleichenden Untersuchung betrug der Median der Krankenhausverweildauer 6 Tage. Damit liegt die Krankenhausverweildauer trotz der Komorbidität der HIV-positiven Patientinnen unterhalb der entsprechend der Bundespflegesatzverordnung (BPflV vom 9.12.1997) vereinbarten Krankenhausverweildauer nach einer Sectio caesarea ab dem 260.…”

Section: Anästhesie-und Operationsrelevante Zeiten Krankenhausverweiunclassified

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An�sthesiologische Versorgung von HIV-positiven Schwangeren zur elektiven Sectio caesarea

et al. 2003

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“…At present, there are no special anesthetic drugs or methods to administer to HIV-infected patients (Krugova et al, 2010;Bajwa and Kulshrestha, 2013). Whether common methods, such as general anesthesia, local anesthesia, or combined spinal epidural anesthesia (CSEA) (Avidan et al, 2002), that were administered to HIV-infected patients caused different outcomes for patients without HIV-infection is still not well understood (Ayers et al, 1993). Here, we assessed 90 HIV-infected patients who were administered three different anesthetic approaches.…”

Section: Introductionmentioning

confidence: 99%

Effects of different anesthetic approaches on postoperative complications in HIV-infected patients

Zhang¹,

Wang²,

Wang³

et al. 2015

Genet. Mol. Res.

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ABSTRACT. The aim of this study was to investigate the effects of three different methods of anesthesia on patients with human immunodeficiency virus (HIV) infection, which could lead to an improvement in postoperative outcomes in these patients. A total of 90 patients undergoing an operation while being treated for an HIV infection were included in this study. Patients were divided into three groups (N = 30/group) based on the type of anesthesia administered: general anesthesia, local anesthesia, and combined spinal epidural anesthesia (CSEA). The effects of local infiltration of anesthesia and peripheral nerve block local anesthesia were examined in the local anesthesia group. The CSEA group examined the effects of spinal anesthesia in HIV-infected patients. We compared the vital (2015) signs of the three groups during the preoperative period, at incision, and during the postoperative recovery period. The CSEA group had a significantly higher mean preoperative CD4 + T lymphocyte count compared with the general anesthesia and local anesthesia groups (P < 0.05). We found that the three kinds of anesthesia methods administered to HIV-infected patients could be used with considerable safety and can be selected according to the clinical need and type of surgical procedure.

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Low Complication Rate Associated with Cesarean Section under Spinal Anesthesia for HIV-1–Infected Women on Antiretroviral Therapy

Abstract: Elective cesarean section under spinal anesthesia for women infected with HIV-1 taking antiretroviral therapy was not associated with intraoperative or postoperative complications.

Cited by 65 publications

References 17 publications

Antiretroviral therapyand anaesthesia

Antiretroviral therapyand anaesthesia

An�sthesiologische Versorgung von HIV-positiven Schwangeren zur elektiven Sectio caesarea

Effects of different anesthetic approaches on postoperative complications in HIV-infected patients

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