Anesthesia and HIV Flashcards
HAART
- Highly activate anti-retroviral therapy
- Halts HIV replication and delays transition from HIV to AIDS
What are some respiratory effects of HIV and how might they affect your care/plan?
- many opportunistic infections: PCP, bacterial PNA, TB, Aspergillosis, CMV, oral candidiasis, Kaposi’s sarcoma, herpes
- direct HIV pulmonary destruction leading to respiratory failure, chronic lung disease
- Care/plan: You would be more inclined to order pulmonary function tests.
- dynamic airway collapse more likely if they have history of karposi’s sarcoma
Some side effects of protease inhibitors:
- Increased cortisol
- hyperglycemia
- hyperlipidemia–> athlerosclerosis
- redistribution of fat
- sunken face, humps on back
Kaposi’s Sarcoma
Type of cancer that can grow on skin or lymph nodes when pt is immunocompromised
*when lymph nodes are involved, pt is at higher risk of airway collapse
*higher risk of bleeding with airway instrumentation
What are some cardiac effects of HIV and how will they affect your plan of care?
- Pericarditis
- pericardial effusion
- myocarditis
- dilated cardiomyopathy
- endocarditis
- PHTN
- thromboembolus
- CAD/MI
- aortic aneurisms- from weakened vascular walls
- 50% of HIV pts will have an abnormal echo
What are some GI effects of HIV?
- opportunistic infections
- GI bleeding
- cholecystitis
- anorexia
- N/V
- dysphagia (dandida albicans
- esophagitis
What are some Renal effects of HIV and how may they effect your plan of care?
- Nephropathy
- meds can damage kidney
- lower threshold for BUN, CR
What are some Endocrine effects of HIV and how my they effect your plan of care?
- Adrenal insufficiency (in advanced AIDS)- may have to give high dose steroids
- Glucose intolerance (related to HAART)
What are some hematologic complications with HIV?
- Anemia
- Leukopenia
- lymphoma
- thrombocytopenia
What are some neurologic complications of HIV?
- CNS is a large reservoir for HIV
- sensory neuropathy- numbness, tingling,
- we want to know if they already have neuropathy so we know we didnt cause it by positioning
- Encephalopathy or dementia- cognitive, motor, and behavioral changes
- Opportunistic infections/ malignancies- brain tumors
- HAART related cerebral vascular disease
What anesthesia interactions can you expect with Nucleoside reverse transcriptase inhibitors?
Other Side effects?
- Can change drug clearance and effect of methadone
- Nausea, diarrhea, myalgia, increase LFTs, peripheral neuopathy, marrow suppression, inhibition of CYP450
What anesthesia interactions can you expect with Non-nucleoside reverse transcriptase inhibitors?
Other side effects?
- extends the half life and effects of:
- midazolam, diazepam, triazolam
- fentanyl, meperidine, methadone
- Nevirapine- induces CYP450
- Delavirdine- inhibition of CYP450- decreased fentanyl clearance by about 67%
What anesthesia interactions can you expect with Rotanavir (protease inhibitors)?
Other side effects?
- Prolongs the half life and effects of:
- amiodarone, digoxin
- diazepam, midazolam, triazolam
- fentanyl, meperidine, methandone
- inhibits CYP450
- hyperlipidemia, glucose intolerance, abnormal fat distribution
What anesthesia interactions can you expect with integrase strand transfer inhibitors?
none
What kind of anesthesia interactions can you expect with early inhibitors?
- changes clearance and effect of midazolam
Would you give decadron to a patient on zidovudine (a Nucleoside reverse transcriptase inhibitor)?
No, corticosteroids with zidovudine can cause sever myopathy including respiratory muscle dysfunction.
Why would you avoid giving meperidine to a patient on HAART?
- High levels can cause seizures and the interaction with HAART will increase half life and doses will build faster than normal.
How would you prepare pre-operatively for an HIV patient?
- universal precautions
- routine sterilization (Na hypochlorate)
- carefully review progression of diseas and organ involvement
- remember that this person will not be as well as their age or appearance indicates
- look up drug regimen and side effects
- understand lab results
What lab values would you look at in an HIV pt?
- CD4 count
- <200 mm3 is not ideal, may want to wait until pt is optimized
- >500mm3 is more encouraging
- T lymphocyte counts: <200 not ideal
- Viral load- evaluates therapy efficacy, but does not have significan effect on anesthetic outcome
- more likely to get:
- CBC, CMP, coags
- CXR
- EKG
- ECHO, PFT
General anesthesia considerations for patients with HIV/AIDS
- VA can suppress immune system, but doesnt seem to cause major issue
- Underlying pulmonary disease- avoid intubation if disease is extensive
- buffalo hump and Kaposi’s sarcoma can make intubation more difficult
- be careful when titrating anesthetics
- anemia, CYP450 inhibitions
- Caution with Succ with peripheral neuropathy, myopathy, spinal cord involvement
Regional anesthesia considerations for HIV/AIDS patients
- No longer as controversial
- contraindications:
- coagulopathy, infection at site, focal neurologic lesions, increased ICP
- less opioic required because of change in clearance related to HAART
