The potential anesthetic threats, challenges and intensive care considerations in patients with HIV infection

Abstract

Acquired immunodeficiency syndrome (AIDS) has become a pandemic with ever looming danger of its transmission in health professionals. The number of AIDS patients has increased tremendously over the last two decades, who present for surgical procedures as well as who get admitted in intensive care unit for their critical condition. As such anesthesiologists and intensivists are exposed to potential risk of disease transmission on a daily basis from such patients. The guidelines and protocols formulated in the western world regarding prevention of disease transmission cannot be applied uniformly in the developing nations, such as India due to various factors and limitations. As such there is a continuous need felt in this arena to prevent the catastrophic consequences of AIDS in our medical fraternity while treating such patients in operation theatres and critical care units. This study reviews the various pathophysiological aspects, anesthetic considerations, intensive care implications, and various areas where current knowledge about AIDS can be applied to prevent its potential transmission in high-risk clinical groups.

Acute abdomen in the immunocompromised patient: WSES, SIS-E, WSIS, AAST, and GAIS guidelines

“…In HIV-positive patients under general anesthesia, pharmacokinetic interactions of antiretroviral therapy with cytochrome 450 enzyme should be considered [ 172 ]. Drugs like etomidate, atracurium, remifentanil, and desflurane can be safely used as their metabolism is independent of the cytochrome 450 enzyme [ 172 ].…”

Antibiotics usage in food-producing animals in South Africa and impact on human: Antibiotic resistance

“…Bacterial infections are quite frequent in HIV-infected patients (Carrega et al, 1997). This is because HIV-induced immunosuppression amplifies the risk of bacterial infections, TB and non-tuberculosis, often involving antibiotic-resistant strains, with severe and/or recurrent potential (Stoian, 2013).For example, infections such as respiratory failure in HIV infected patients are bacterial pneumonias which have been reported to be caused by Pseudomonas, Staphylococcus aureus and other bacteria (Bajwa and Kulshrestha, 2013).In 2009 an estimated 29% (over 5.5 million) of people were infected with the HIV virus (Crowther-Gibson et al, 2011). Moreover, some evidence indicate that antibiotic resistance rate to nosocomial pathogens are generally high in South Africa (Nyasulu et al, 2012).…”

Clinical Conundrums in Management of Hypothyroidism in Critically Ill Geriatric Patients

“…The challenges increase manifold in elderly diabetic and obese patients with associated thyroid disorders ( 63 , 64 ). A new challenge has been encountered in today’s critical care setting, as many patients with AIDS are admitted with various endocrine disorders( 65 ). Elderly are often on polypharmacy and thyroid medications may be lost during medication reconciliation in transition from oral to enteral route in the ICU ( 66 ).…”