Transcript 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
Mode of Transmission
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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
AIMS
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Prevent transmission
 Patient to patient
 Patient to personal health care provider
Know pathophysiology of the infectious
diseases
Know side effects of medications
Respiratory diseases
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Tuberculosis
H1N1 influenza
H5N1 influenza
SARS
Tuberculosis
Tuberculosis
Diagnosis
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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
Medications
Drug
Dose
Side effect
First Line Drugs
Isoniazid
5 mg/kg (300mg) Hepatoxicity
peripheral neurotoxicity
drug interactions
Rifampin
10 mg/kg
(600mg)
Hepatoxicity
thrombocytopenia
gastrointestinal upset
drug interactions
Pyrazinamide Based on weight Hepatotoxicity
Ethambutol
50 mg/kg (2 g)
gastrointestinal upset
Arthraglia
15– 20 mg/kg
daily
Ocular neuritis
Anesthetic management
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Elective surgery should be postponed
until they are no longer contagious
(three negative sputum smears,
improving symptoms and chest X ray)
Anesthetic management
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Liver function test, serum creatinine
and platelet count should be
performed
If ethambutol is used, visual acuity
and color vision should be assessed
Anesthetic management
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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
Anesthetic management
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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
Anesthesia management
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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
H1N1 infection
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Spread of infection to others
Hyper reactive airway
Reduced pulmonary functions and
Involvement of other body organs
H1N1 infection
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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
H1N1 infection
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HEPA filters, connected between patient
outlet and standard anaesthesia tubing
a closed system suction catheter should
be used
HIV infection
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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.
HIV infection
HIV infection
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Neurologic system
Respiratory system
Hematologic system
Cardiovascular system
Gastrointestinal system
AIDS
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Bacterial infection, multiple or recurrent
Candida of the bronchi, trachea, lungs, or esophagus
CD4+ T lymphocyte count น้อยกวา่ 200 cells/µL3
Cervical cancer, invasive
Coccidioidomycosis, disseminated or
extrapulmonaryCryptococcosis, extrapulmonary
Cryptosporidiosis, chronic intestinal (>1 month)
Cytomegalovirus other than liver, spleen, lymph
nodes
AIDS
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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
AIDS
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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
Medications
Category
Examples
Nucleoside/Nucleotide Reverse
Transcriptase Inhibitors
(NRTIs)
zidovudine (AZT), didanosine,
zalcitabine, stavudine,
lamivudine and abacavir
Non-Nucleoside Reverse
Transcriptase Inhibitors
(NNRTIs)
nevirapine, delavirdine, and
efavirenz
Protease Inhibitors
amprenavir, fosamprenavir,
atazanavir, saquinavir,
ritonavir, indinavir and nelfinavir
Fusion Inhibitors
enfuvirtide
Integrase Inhibitors
raltegravir
Side Effects
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Inhibit cytochrome P-450 (CYP)3A4
Glucose tolerances
HAART has both direct hepatotoxicity
and nephrotoxicity
Anesthetic management
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CD4 count < 200 cells/µL3 be treated
with anteretroviral drugs
History and physical exam
CBC, coagulation profile, LFT, BUN/Cr,
electrolyte
Chest radiography
ECG
Anesthetic management
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GA or RA
Universal precaution
Prevent transmission
Universal Precuation
1. มีสข
ุ ภาพอนามัยดีพร
อมทัง้ กายและใจ
2. การรักษาความสะอาดของที่ทาํ งาน
3. การระมัดระวังไม ให สัมผัสสารคัดหลัง่
4. การสวมเครื่องป องกันให เหมาะสม
5. การตระหนักการป องกันการติดเชื้อ
เช น มีสมาธิ หมันล
่ างมือ
Universal Precuation
Precaution Apparatus
- ถุงมือ
หน ากาก
- เสื้อกาวน
- รองเท า
-
Safe use and disposal of
sharps
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ลดขัน้ ตอนการส งต อด วยมือ
ไม ควรหักหรืองอของมีคมก อนทิ้ง
ไม ควรปลดเข็มออกจากหลอดฉี ดยาก อนทิ้ง
ควรทิ้งในที่ที่เหมาะสมทันทีหลังใช งาน
ไม ควรใช เข็มที่มีคมดูดยา
ทิ้งภาชนะของมีคมเมื่อมีของเต็ม 2/3
แนวทางปฏิบ ัติเมือ
่ ถูกของมีคมตา
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ล ้างแผลบริเวณผิวหนังด ้วยน้ าสบู่
mucosa ล ้างด ้วยน้ าเกลือ
ื้
พบแพททย์ทันทีเพือ
่ ประเมินการติดเชอ
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
HBV
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HBIG ภายใน 24 ชวั่ โมงเพือ
่ เป็ น passive
prophylaxis
HBV vaccine
Signs and serology until 6 months
HCV
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Check anti-HCV and alanine
aminotransferase activity
Follow up 4-6 months
ถาผล
anti-HCV positive ควรตรวจ
้
recombinant immunoblot essay เพือ
่
ยืนยันการติดเชือ
้
HIV
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antiretroviral agents for postexposure
prophylaxis in24-36 hrs
Follow up serology after 6, 12 weeks
and 6 months
Conclusion
Blood-borne
Universal precaution
Precaution apparatus
Hand Hygiene
Sharps
การทําความสะอาด
อุปกรณ์
Air-borne
Universal precaution
Mask n-95
Isolation
Prepare anesthesia
circuit
การทําความสะอาด
อุปกรณ์์