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Anesthesia for Infectious Diseases

Anesthesia for Infectious Diseases . Kanya Kumwilaisak MD Department of Anesthesiology Faculty of Medicine Chulalongkorn University. Infectious Disease. An infectious disease is a clinically evident illness resulting from the presence of pathogenic microbial agents .

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Anesthesia for Infectious Diseases

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  1. Anesthesia for Infectious Diseases Kanya Kumwilaisak MD Department of Anesthesiology Faculty of Medicine Chulalongkorn University

  2. Infectious Disease An infectious disease is a clinically evident illness resulting from the presence of pathogenic microbial agents

  3. Mode of Transmission • Respiratory system : contact with aerosolized droplets, spread by sneezing, coughing, talking, kissing or even singing • Gastrointestinal system : are often acquired by ingesting contaminated food and water • Sexually transmitted diseases :are acquired through contact with bodily fluids, generally as a result of sexual activity

  4. AIMS • Prevent transmission • Patient to patient • Patient to personal health care provider • Know pathophysiology of the infectious diseases • Know side effects of medications

  5. Respiratory diseases • Tuberculosis • H1N1 influenza • H5N1 influenza • SARS

  6. Tuberculosis

  7. Tuberculosis

  8. Diagnosis • Symtoms : Persistent cough (eg, lasting longer than 2 weeks),fever, night sweats, weight loss, shortness of breath, haemoptysis, and chest pain. • Positive tuberculin skin test • Sputum exam and culture

  9. Medications

  10. Anesthetic management • Elective surgery should be postponed until they are no longer contagious (three negative sputum smears, improving symptoms and chest X ray)

  11. Anesthetic management • Liver function test, serum creatinine and platelet count should be performed • If ethambutol is used, visual acuity and color vision should be assessed

  12. Anesthetic management • Type of anaesthetic technique will depend on the type of surgery and degree of involment of respiratory tract • regional anaesthesia, patient must wear N95 mask

  13. Anesthetic management • OR with an antechamber or separated from other areas • The fewest health care workers • HEPA filters are placed between patient and the ventilator • N95 mask in infectious particles area

  14. Anesthesia management • CO2 absorber should be discarded • Two bacterial filters at Y-piece and expiratory limb— a case report • Should delay at least 1 hour for the next case • No O2 flush for checking circuit

  15. H1N1 infection • Spread of infection to others • Hyper reactive airway • Reduced pulmonary functions and • Involvement of other body organs

  16. H1N1 infection • Postpone elective surgery till patient is H1N1 negative • In emergent H1N1 positive, it is prudent to operate in an Operation theatre with all precautions as per guidelines for infectious diseases like TB • Patient should be isolated throughout the stay in the hospital

  17. H1N1 infection • HEPA filters, connected between patient outlet and standard anaesthesia tubing • a closed system suction catheter should be used

  18. HIV infection • Human immunodeficiency virus (HIV) is a lentivirus (a member of the retrovirus family) that causes acquired immunodeficiency syndrome (AIDS) • Infection with HIV occurs by the transfer of blood, semen, vaginal fluid, pre-ejaculate, or breast milk.

  19. HIV infection

  20. HIV infection • Neurologic system • Respiratory system • Hematologic system • Cardiovascular system • Gastrointestinal system

  21. AIDS • Bacterial infection, multiple or recurrent • Candida of the bronchi, trachea, lungs, or esophagus • CD4+ T lymphocyte count น้อยกว่า 200 cells/µL3 • Cervical cancer, invasive • Coccidioidomycosis, disseminated or extrapulmonaryCryptococcosis, extrapulmonary • Cryptosporidiosis, chronic intestinal (>1 month) • Cytomegalovirus other than liver, spleen, lymph nodes

  22. AIDS • Cytomegalovirus retinitis or CMV (with loss of vision)Herpes simplex virus with chronic ulcers (> 1 month), bronchitis, pneumonitis, esophagitis • HIV related encephalopathy • Histoplasmosis, disseminated or extrapulmonaryIsophoriasis, chronic intestinal (>1month) • Kaposi’s sarcoma • Burkitt’s lymphomaImmunoblastic lymphoma • Lymphoma of the brain, primary

  23. AIDS • Mycobacterium avium complex or kansasii, disseminated or extrapulmonary • Mycobacterium tuberculosis, any site • Mycobacterium, any other species, pulmonary or extrapulmonary • Pneumocystis carinii pneumonia • Pneumonia, recurrent • Progressive multifocal leukoencephalopathy • Recurrent Salmonella septicemia • Toxoplasmosis of the brain • Wasting syndrome due to HIV

  24. Medications

  25. Side Effects • Inhibit cytochrome P-450 (CYP)3A4 • Glucose tolerances • HAART has both direct hepatotoxicity and nephrotoxicity

  26. Anesthetic management • CD4 count < 200 cells/µL3 be treated with anteretroviral drugs • History and physical exam • CBC, coagulation profile, LFT, BUN/Cr, electrolyte • Chest radiography • ECG

  27. Anesthetic management • GA or RA • Universal precaution • Prevent transmission

  28. Universal Precuation 1. มีสุขภาพอนามัยดีพรอมทั้งกายและใจ 2. การรักษาความสะอาดของที่ทํางาน 3. การระมัดระวังไมใหสัมผัสสารคัดหลั่ง 4. การสวมเครื่องปองกันใหเหมาะสม 5. การตระหนักการปองกันการติดเชื้อ เชน มีสมาธิ หมั่นลางมือ

  29. Universal Precuation Precaution Apparatus - ถุงมือ - หนากาก - เสื้อกาวน - รองเทา

  30. Safe use and disposal of sharps • ลดขั้นตอนการสงตอดวยมือ • ไมควรหักหรืองอของมีคมกอนทิ้ง • ไมควรปลดเข็มออกจากหลอดฉีดยากอนทิ้ง • ควรทิ้งในที่ที่เหมาะสมทันทีหลังใชงาน • ไมควรใชเข็มที่มีคมดูดยา • ทิ้งภาชนะของมีคมเมื่อมีของเต็ม 2/3

  31. แนวทางปฏิบัติเมื่อถูกของมีคมตำแนวทางปฏิบัติเมื่อถูกของมีคมตำ • ล้างแผลบริเวณผิวหนังด้วยน้ำสบู่ • mucosa ล้างด้วยน้ำเกลือ • พบแพททย์ทันทีเพื่อประเมินการติดเชื้อ

  32. Information for an Occupational Exposure Report 1. Date and time of exposure 2. Detailed description of the procedure being performed 3. Details of the exposure 4. Details regarding the exposure source such as known HBV, HCV, or HIV infection 5. Details about the exposed HCW such as a history of hepatitis B vaccination and antibody status 6. Details about counseling, postexposure management, and follow-up

  33. HBV • HBIG ภายใน 24 ชั่วโมงเพื่อเป็น passive prophylaxis • HBV vaccine • Signs and serology until 6 months

  34. HCV • Check anti-HCV andalanine aminotransferase activity • Follow up 4-6 months • ถ้าผล anti-HCV positive ควรตรวจ recombinant immunoblot essay เพื่อยืนยันการติดเชื้อ

  35. HIV • antiretroviral agents for postexposure prophylaxis in24-36hrs • Follow up serology after 6, 12 weeks and 6 months

  36. Conclusion Air-borne Universal precaution Mask n-95 Isolation Prepare anesthesia circuit การทําความสะอาดอุปกรณ์ Blood-borne Universal precaution Precaution apparatus Hand Hygiene Sharps การทําความสะอาด อุปกรณ์

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