Perioperative considerations of the patient with malaria

Abstract

Purpose Malaria is a life-threatening infectious disease caused by the Plasmodium parasite. Increased global travel has resulted in an escalation in the number of imported cases seen in developed countries. Patients with malaria may present for surgery in both endemic and nonendemic countries. This article reviews the perioperative considerations when managing patients with malaria. Source A literature review of anesthesia, perioperative care, and malaria-related articles was performed using the MEDLINE Ò , EMBASE TM , and Web of Science databases to identify relevant articles published in English during . Of the 303 articles matching the search criteria, 265 were excluded based on title and abstract. Eleven of the remaining 38 articles were relevant to anesthesia/perioperative care, and 27 articles were identified as having direct relevance to critical care medicine. Principal findings The majority of imported malaria cases are caused by the falciparum species, which is associated with the greatest degree of morbidity and mortality. Various organ systems may be impacted as a consequence of changes in the structure and function of parasitized erythrocytes. Preoperative assessment should focus on establishing the species of malaria, the severity of disease, assessing the degree of end-organ impairment, and initiating treatment of malaria prior to surgery. Intravenous artesunate is the treatment of choice for severe falciparum malaria. Quinine is a second-line agent but has a narrow therapeutic index and particularly hazardous side effects. Intraoperatively, attention should focus on fluid management, dynamics of cerebral blood flow, and avoidance of hypoglycemia. Postoperative care of severe cases should ideally take place in a critical care unit as there may be ongoing requirements for multi-organ support, including renal replacement therapy, ventilation, and/or inotropic support. The safety of neuraxial anesthesia has not been well studied in the setting of malaria. Conclusions Malaria remains one of the most devastating infectious diseases worldwide. Multiple organ systems can be impacted as a consequence of changes in structure and function of parasitized erythrocytes. Safe perioperative management requires a sound knowledge of all these potential system effects. RésuméObjectif Le paludisme est une maladie infectieuse possiblement fatale due au parasite Plasmodium. La multiplication des voyages à travers le monde a entraîné un accroissement du nombre de cas importés observés dans les pays développés. Les patients atteints de paludisme peuvent nécessiter une chirurgie, aussi bien dans les pays où la maladie est endémique que dans les autres. Cet article passe en revue les considérations périopératoires lors de la prise en charge de patients atteints de paludisme. Source Une revue de la littérature à la recherche d'articles d'anesthésie, de soins périopératoires et en Author contributions Daniel Soltanifar, Brendan Carvalho, and Pervez Sultan all made substantial contributions to the literature review, ...

Predictors of Poor Postoperative Outcomes in Pediatric Surgery Patients in Rural Ghana

“…However, the pathophysiological changes caused by malaria infections, including excessive releases of cytokines and chemokines such as tumor necrosis factors and interleukin-2, could alter the healing process postoperatively [30]. Previous studies have suggested that surgery may weaken patients' immune systems, increasing their susceptibility to malaria and its complications or to other pathogens [16].…”

“…Children present with different surgical pathologies, respond differently to anesthesia, and have special perioperative needs associated with high perioperative mortality [5,7]. The vast majority of research on perioperative morbidity and mortality is from developed countries [7][8][9][10][11][12], and the number of studies that have looked at the in uence of medical comorbidities unique to sub-Saharan Africa are limited [13][14][15][16].…”

Tropical medicine and anaesthesia 1

“…The majority of the multi-system manifestations seen are because of the changes in the parasitized erythrocyte; these show a reduced membrane deformability and increased fragility, with accelerated haemolysis leading to an anaemia that may be complicated by direct bone marrow suppression. 4 Increased adherence to the vascular endothelium causes sequestration of red blood cells and microvascular capillary obstruction of the cardiac, renal, hepatic, splenic, and cerebral circulations. Pro-inflammatory cytokines, such as interleukin-1 and tumour necrosis factor, may generate a systemic inflammatory response.…”

“…It has been suggested that surgical stress may cause reactivation of dormant Plamodium vivax or Plamodium ovale. 4 Preoperative evaluation of patients with malaria should include an assessment of the severity of infection and degree of organ impairment (Table 1).…”

Antimalarial and Anti-hypoglycemic Properties of Siamese Neem Tree (Azadirachta indica) in Plasmodium berghei Infected Mice

“…Furthermore, the difficulty of creating efficient vaccines and also adverse side effects of the existing antimalarial drugs highlight the urgent need for new antimalarial drugs for treatment of malaria. In addition, malaria-associated hypoglycemia has been reported during malaria parasite infection, and is one of all most causes of death [7][8][9].…”