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Query: UMLS:C0019693 (HIV)
 170,526 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Questionnaires were distributed to all 213 consultant anaesthetists in the North-West region of the UK with a response rate of 68%. These questionnaires were designed to assess the hygienic precautions taken to reduce the potential for transmission of infectious agents to and from the patients under their care. Face masks and gloves were always used by 35.2% and 14.5%, respectively, while only 36.4% washed their hands between cases. Most respondents have changed their practice since the recognition of HIV transmission (74.8%) and hepatitis B and C (69.8%). A high proportion of anaesthetists continue to administer anaesthesia despite suffering from respiratory (94%), gastrointestinal (42.9%) or herpes simplex (32.6%) infections. The anaesthetic breathing system was changed at the end of each day or following a high-risk case by 33.3% of the respondents, while just over 25% changed it following a known infected case. Bacterial filters were used by 17% and changed after each case by 7.2%. On a scale of 0-10 (10 = significant) anaesthetists rated their potential for transmitting or contributing to patient infection as a median of 3 (interquartile range: 2-6). The results of this study show that, although anaesthetists are well aware of proper hygienic practices, their performance falls short of accepted recommendations.
Anaesthesia 1999 Jan
PMID:Hygienic practices of consultant anaesthetists: a survey in the north-west region of the UK. 1041 79

A review of anaesthesia for patients with HIV-infection is given. The use of new antiretroviral drug combinations to treat HIV-infection may result in longer survival, and therefore more cases of HIV-positive patients who undergo surgery and require anaesthetic services. Clinical manifestations of the HIV infection in humans can be seen in almost every organ. The anaesthetist must have an understanding of the many manifestations of the syndrome. Physical examination and preoperative preparation is essential. Considerations for the anaesthetist include: the effects of medications and possible drug interactions, organ dysfunction, altered metabolism and choice of anaesthetic technique for the HIV-positive patient. Anaesthetists and other health care professionals must know about the manifestations of HIV-infection in order to provide competent and compassionate care.
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PMID:[Anesthesiologic aspects in patients with HIV infections]. 1021 Sep 72

NOSOCOMIAL TRANSMISSION: Increasingly implicated in HCV infection in patients with no patent risk factors, nosocomial transmission has been demonstrated between patients hospitalized in the same ward and from health carers to patients. The risk of HCV transmission by medical instruments could only be quantified with a prospective study of examined patients. There is a theoretical risk for all endoscopic examinations whatever organ explored. Instrumental manipulations have been found as the only risk factor in blood donors. VALUE OF FORMER DISINFECTION GUIDELINES: Disinfection protocols for endoscopes have been found to eliminate 3 viruses (HCV, HBV, HIV). The endoscope-related risk could be due to minimal bleeding provoked by biopsies (risk factors independent of HCV infection) via the operator channel. THREE REPORTED CASES OF HVC INFECTION: One case of HVC infection following retrograde cholangiography and two after coloscopy have been reported. In all three cases disinfection was found to be insufficient. Recently, an official statement by the French health authorities indicates that a 20-min gluteraldehyde bath is necessary for optimal efficacy. Instruments susceptible to cause bleeding must be sterilized. The sterilization process must be tracable. The anesthesia-related risk appears to be due to use of multidose bottles or reuse of syringes. SAFE ENDOSCOPY: Disinfection procedures must be rigorously applied. One new perspective is the culture of titratable virus models. Several arguments show that well-conducted disinfection of endoscopes and medical instruments can eliminate all risk of viral transmission, including HCV.
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PMID:[Risk of transmission of hepatitis C through endoscopy of the digestive tract]. 1039 81

In the national seminar of AIDS and Anesthesia which was a short course educational program in all aspects of HIV medicine, 195 questionnaires about knowledge, attitude and practice concerning HIV were distributed among the participants (anesthesiologists and nurse anesthetists) in 3 periods, pretest, post test (at the end of 2 days seminar) and post test 2 (at 4 months after the seminar). There were 177 (90.76%) respondents who completed both pretest and post test 1 questionnaires. About 12 questions of knowledge; mean scores were statistically significantly increased; 7.95 (0.98) vs 9.5 (0.78), P < 0.001. Two thirds (8 out of 12 questions) were answered correctly in post test 1 more than in the pretest by Mc Nemar Chi-square test; P < 0.05. About attitude; 2 out of 5 answers changed significantly by Mc Nemar Chi-square test; P < 0.05. The post test 2 questionnaires were mailed to all 177 participants twice asking to reply only once. All questionnaires were to be completed anonymously. The post test 2 with a response rate of 65.5 per cent revealed that universal precautions were frequently used among Thai anesthesia personnel but not universally followed. At least one-third of the respondents admitted recapping before disposal of used needles. Fifty six per cent of respondents (vs 22.8% in pretest) admitted re-using one syringe for more than one patient. In conclusion, this study showed that a short course educational program may improve knowledge about HIV and partly change attitude, but can not change behaviour. Changing the practice of anesthesia health care workers needs continual education and appropriate training.
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PMID:Effect of national seminar on AIDS and anesthesia upon knowledge, attitude and practice concerning HIV among Thai anesthesia personnel. 1071 Aug 87

The acquired immune deficiency syndrome has reached pandemic proportions. Anaesthetists should be aware of the implications of dealing with increasing numbers of both diagnosed and undiagnosed, symptomatic and asymptomatic, human immunodeficiency virus-infected patients in the fields of intensive therapy, operating theatre anaesthesia, obstetrics and pain management. With recent advances, important insights have been gained into the pathogenesis of human immunodeficiency virus. Molecular techniques allow quantification of viral burden, and together with CD4 T-lymphocyte count, prognosis and response to therapy can be evaluated. New drugs and therapeutic regimens have improved prognosis for those who are infected with the virus and vertical transmission of infection from mother to infant can be minimised. Should accidental occupational exposure to the virus occur, a prophylactic regimen of antiretroviral drugs can be administered in an attempt to prevent subsequent human immunodeficiency virus infection.
Anaesthesia 2000 Apr
PMID:The implications of HIV for the anaesthetist and the intensivist. 1128 30

Tissue biopsy sampling by laparotomy is considered major surgery, which precludes serial sampling. This increases variability and requires a larger n value for pathogenesis studies. To address this problem, a study was conducted to develop and validate the feasibility of performing multiple, serial biopsy sampling by laparoscopy in pigtail macaques. Tissues were obtained laparoscopically from 2 HIV-negative and 2 HIV-positive (late postinoculation) macaques on days 0, 3, and 7, followed by necropsy on day 21. Anesthesia was induced with ketamine and atropine and maintained with isoflurane. Carbon dioxide pneumoperitoneum was maintained at 6 mm Hg. A triangulated threeport technique was used for insertion of pediatric (3.5-5.0 mm) laparoscopic instrumentation. Biopsies of kidney and spleen were obtained with a core-sampling biopsy needle, of small intestine and mesenteric lymph node with a pretied loop, and of liver with 3.5-5.0 mm biopsy forceps. Analgesics were administered for 24 h post operation, and animals were evaluated for postoperative complications. All monkeys maintained a good appetite. Mild postoperative pain was observed in one animal after the second surgery. There was no excessive bleeding or intestinal stenosis at biopsy sites. Skin infection, observed in 1/36 (2.8%) port sites, resolved with systemic antibiotics. Significant adhesions formed at 23/114 (20.2%) sites. Out of 34 samples evaluated for histopathology, 29 (85.3%) were satisfactory (minimal to mild tissue crushing). In situ hybridization results revealed few (4 of 29 samples tested) positive cells, which is consistent with the low level of HIV-2 virus found in cells late in the postinoculation period in pigtail macaques. The results of this study suggest that laparoscopic serial abdominal biopsy collection in healthy and immunocompromised pigtail macaques may be considered a minor procedure, and can be used to expedite serial tissue collection in survival studies.
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PMID:Videoendoscopic techniques for collection of multiple, serial intra-abdominal biopsy specimens in HIV-negative and HIV-positive pigtail macaques (Macaca nemestrina). 1099 98

There is a need for a rapid and efficacious method of diagnosis of pulmonary infiltrates in perinatal HIV infection. However, controversy still exists about which method--open lung biopsy (OLB) versus bronchoscopic techniques--is the best for this population. We present our results with OLB in 24 children with HIV-related lung disease. Over a 6-year period, 27 OLBs were performed on 24 children with diagnosis of HIV infection. The procedures were performed under general anesthesia using a limited anterolateral thoracotomy. Suspicious areas were removed with the autostapler. The specimens were studied for the presence of non-infectious as well as bacterial, viral, fungal, and mycobacterial diseases. There were no operative deaths related to the procedure. Morbidity was limited to prolonged but self-resolving air leaks in two patients (8.3%). Five hospital deaths occurred between 3 and 12 weeks postoperatively and 11 late deaths between 3 months and 6.5 years. All deaths were related to AIDS. Eight patients (33.3%) are still alive 2 to 8 years postoperatively. A total of 43 pathologies were found in 27 specimens. A positive pathologic finding was obtained in all patients, with two patients having nonspecific minimal changes. This resulted in a change of therapy in all but one case. The technique of OLB in children with AIDS is safe and simple. It should be performed early in the course of the disease and, a careful selection of candidates can minimize the incidence of complications.
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PMID:The role of lung biopsy in children with perinatally acquired AIDS. 1136 72

An anesthesia technician won a $615,000 lawsuit against Becton Dickinson and Company because the company's unshielded catheter was implicated by the technician in an occupational transmission of HIV. The out-of-court settlement was made public despite Becton Dickinson's attempts to conceal the decision.
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PMID:HIV-infected worker settles device lawsuit. 1136 30

Many medications for HIV-related infections are more effective when administered intravenously, and some can be safely and effectively administered at home. Generally, the patient has a catheter inserted, which may be either a superficial catheter (changed frequently and prone to infections) or a central catheter (permanently implanted under local anesthesia). Regardless of type, catheters require special care to reduce the likelihood of infection. Catheters allow a measured amount to be injected, and in some cases are used to administer nutritional supplements. Characteristics of several brands are described.
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PMID:Home infusion. 1136 9

Non-healing wounds (NHW) following anorectal surgery cause great distress to the patient and may be followed by a retracting scar causing anal deformity and incontinence. The management of NHW is controversial. The aim of this study was to review our experience with reconstructive perineoplasty in the treatment of such condition. From January 1992 to June 2000, we treated 12 patients affected by NHW (4 men and 8 women, mean age 47 years), not responding to conservative treatment. None had Crohn's disease or HIV infection. Pre- and postoperative anal manometry and ultrasound were carried out in 8 patients. All had microspinal anesthesia, mechanical preparation of the intestine, and perineal wound cleansing. Reconstructive perineoplasty was performed by means of local flaps (i. e. cutaneous, fasciocutaneous, myocutaneous). Median follow-up was 13 months (range, 1 to 70). Postoperative complications were as follows: 5 perineal suture dehiscences (1 total, 4 partial), the flap being resutured in one case under local anesthesia; one patient required dilatations for mild anal stricture. No case of gross fecal incontinence, retracting scar or perineal ulcer was observed. Among those patients who had disordered anal continence prior to surgery, all but one improved continence score following perineoplasty from 2.8+/-2.2 to 1.8+/-1.2 (mean +/- sdm, not significant). Following reconstructive perineoplasty, no significant change was observed in functional and morphologic patterns of the anal sphincters either at manometry or by ultrasound. Reconstructive perineoplasty resulted in a good functional and clinical outcome in most cases and, therefore, may be considered an effective procedure in the management of NHW.
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PMID:Reconstructive perineoplasty in the management of non-healing wounds after anorectal surgery. 1179 57


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