Anaesthetic considerations for the HIV positive parturient

Abstract

The HIV epidemic in children parallels that among women on account of perinatal transmission. A combination of antiretroviral therapy and elective caesarean section reduces the rate of vertical transmission to <2%. Elective caesarean section independent of antiretroviral therapy decreases the risk of HIV vertical transmission from mother to baby. However, a caesarean section is a major surgical intervention that has well-reported complications. Women infected with HIV have been reported to be more susceptible to such complications. The multi-organ nature of HIV poses challenges at the time of surgery and anesthesia. Preoperative evaluation will allow a good prediction for the perioperative risk of the HIV-patient. The anesthesiologist should be aware of the possible toxic side effects or the possible interaction of antiretroviral drugs with the anesthetics. Some of these adverse effects may mimic signs and symptoms of the HIV disease itself. Regional anesthesia has been shown to be associated with reduced morbidity and mortality in a wide range of patients, including HIV positive parturients. Finally, the possibility of transmission in the health care setting highlights the need for anesthetists to enforce rigorous infection control policies to protect themselves, other health workers and their patients.

Psychological Status Among Anesthesiologists and Operating Room Nurses During the Outbreak Period of COVID-19 in Wuhan, China

“…Facing the critical situations, being female, living in suburb areas, shortage of protective medical equipment and close contact with COVID-19 patients were associated with depression and anxiety of anesthesiologists and OR nurses. Anesthesiologists and OR nurses are at high risk of occupational exposure to infectious diseases (7)(8)(9)(10). During the initial phase of the COVID-19 outbreak, the majority of hospitals in Wuhan were faced with a severe shortage of required personal protective equipment and SARS-CoV-2 Nucleic Acid Diagnostic Kits.…”

“…Besides, anesthesiologists also joined in the medical corps in Leishenshan and Fangcang hospital and provided care for COVID-19 patients as experts in emergent airway management and intensive care, which imposed a significant risk to their own health. Anesthesiologists and operating room (OR) nurses are exposed to droplet or blood-borne transmission of pathogens during endotracheal intubation and open surgical procedures, which put them at high potential of nosocomial infection (7)(8)(9)(10)(11)(12)(13). The operating room staffs thus face the risk of occupational exposure to COVID-19 patients.…”