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Query: UMLS:C0021051 (immunodeficiency)
 71,517 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Over the last 20 years, the acquired immune deficiency syndrome (AIDS) has grown from a small case series of Pneumocystis carinii infection in four homosexual men to one of the major health problems facing the world today. In the next 5 years, human immunodeficiency virus (HIV) infection is expected to kill more than 2.2 million people. In the United States, women of childbearing age constitute a large percentage of new cases of AIDS. Because of the increased prevalence of HIV in pregnant women, many anesthesiologists encounter these patients in their practice. The safety of regional neuraxial spread has been a concern in the past, nevertheless, recent analysis of the problem has shown that HIV infection in pregnancy does not contraindicate administration of regional anesthesia.
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PMID:Human immunodeficiency virus in the parturient. 1277 Jun 62

The pandemic of acquired immune deficiency syndrome (AIDS) is on the threshold of its third decade of existence. The World Health Organization-United Nations statistics show that human immunodeficiency virus (HIV)/AIDS pandemia is set to get much worse. Women of reproductive age are the fastest growing population with HIV. Common signs and symptoms have become more moderate or subclinical, and new clinical presentations have emerged. It is quite apparent that HIV-disease affects multiple organ systems. Advances have been made in elucidating the pathogenesis of HIV. In addition, the molecular technique of viral load determination and the CD + 4 T-lymphocyte count enable evaluation of the disease, its prognosis, and its response to therapy. There is limited specific information concerning the overall risk of anesthesia and surgery of HIV/AIDS patients. However, as far as can be determined, surgical interventions do not increase the postoperative risk for complications or death and should therefore not be withheld. There is also little evidence to suggest that HIV or antiretroviral drugs increase the rate of pregnancy complications or that pregnancy may alter the course of HIV infection. General anesthesia is considered safe, but drug interactions and their impact on various organ systems should be considered preoperatively. Regional anesthesia is often the technique of choice. Yet, one must take into consideration the presence of neuropathies, local infection, or blood clotting abnormalities. It should be emphasized that all practicing anesthesiologists should be familiar with the disease and should use prenatal anesthesia consultations and a team approach to assure optimal treatment for HIV patients.
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PMID:Human immunodeficiency virus: anesthetic and obstetric considerations. 1474 95

We wished to determine whether immunosuppression and/or acceleration of human immunodeficiency virus (HIV)-associated disease is related to the mode of anesthesia in the HIV infected parturient. Ninety-six known HIV-infected asymptomatic parturients who delivered between January 1990 and January 1992 at Grady Memorial Hospital were reviewed for pre-delivery health status, mode of anesthesia and peripartum/post-partum complications. Statistics used chi2 analysis. There were 36 regional anesthetics (28 epidural, 8 spinal), 11 general anesthetics, 22 local anesthesia/intravenous sedation and 27 patients who did not receive anesthesia. There were no differences in the 24-48 h and 4-6 week complication rates. None of the women studied developed neurologic sequelae for 2 years after anesthesia. Thirty-one of the 96 women had CD4/CD8 T-cell lymphocyte data at second trimester and 24-48 h post partum which showed no worsening of maternal immune status in women receiving regional anesthesia, local anesthesia/intravenous sedation or no anesthesia. We believe that both regional and general anesthesia can be performed safely on the asymptomatic HIV-infected parturient. The choice of anesthesia should be based on the usual obstetric and clinical considerations.
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PMID:Anesthesia and the HIV infected parturient: a retrospective study. 1532 Dec 85

We present a case of a human immunodeficiency virus (HIV) positive, poly-substance abusing parturient who presented for an emergency cesarean section following recent cocaine and alcohol intake. Spinal anesthesia was selected for the abdominal delivery. 4 min after delivery of the fetus, the patient developed hypotension, intermittent runs of ventricular tachycardia, premature ventricular complexes and ST-segment elevation. Induction of general anesthesia, endotracheal intubation, intravenous lidocaine and phenylephrine were required to restore stability. At the end of surgery the patient was stable and was extubated. The ST-segment elevation returned to normal 45 min postoperatively. Her postoperative course was uneventful.
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PMID:Cesarean section in a parturient with HIV and recent cocaine and alcohol intake: anesthetic implications. 1532 67

Surgical stress resulting from the operative morbidity and narcosis aggravates the associated age-related and secondary immunodeficiency of gerontological patients at surgeries. Stress hormones have a strong depressing effect on the immunity by forming stress immunodeficiency. Not only high blood level determines the damaging effect of stress hormones but also the activity of stress-limiting mechanisms of the immune system protect it from the damaging effect of stress hormones. In this connection, the impact of operative morbidity and anesthetic aggression on the activity of stress-realizing and, in particular, stress-limiting mechanisms plays an important role because of the frequency of postoperative complications in gerontological patients namely. We observed patients operated on the abdominal cavity by urgent indications with a delay or based on a schedule under conditions of epidural anesthesia (45 patients), spinal anesthesia (43 patients) and general anesthesia (41 patients). The analysis of data obtained shows that different types of anesthesia have different effect on the plasmic cortisol level and activity of stress-realizing and stress-limiting systems. Thus, in case of epidural anesthesia of gerontological patients it was possible to observe the reduction of the high plasmic cortisol level and activation of stress-limiting reception of immunocompetent cells contributing to the preservation of the immune function. The increased plasmic cortisol level accompanied spinal anesthesia applied to such patients. However, it did not suppress the stress-limiting reception protecting the immunity against the damaging action of cortisol. In case of general anesthesia of gerontological patients it was possible to observe the increased blood cortisol level and decreased activity of protective stress-limiting receptors contributing to the formation of glucocorticoid immunosuppression.
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PMID:[The impact of the type of anesthesia on stress-realizing and stress-limiting mechanisms of the immune system in gerontological patients at abdominal surgeries]. 1556 Apr 4

As a rule, gerontological patients have a combination of senile physiological immunodeficiency and secondary immunodeficiency caused by various diseases. These states of the immune system are aggravated by stress immunodeficiency formed as a result of operative traumas and anesthesia. The immunodeficiency state (IDS) of such patients in many respects is determined by their interleukine status. Patients operated on abdominal cavity organs by the life-saving indication according to a delayed or scheduled procedure under conditions of epidural anesthesia (45 patients), spinal anesthesia (43 patients) and general anesthesia (41 patients) were examined. When generalizing the obtained results, it is necessary to mention that various types of anesthesia have a different effect on the immune and interleukine status of gerontological patients.
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PMID:[Effect of the anesthesia method on the immune status of gerontological patients during abdominal operations]. 1556 72

We report a previously undescribed method of removing multiple oral papillomas, which we performed on 5 men with human immunodeficiency virus (HIV) infection. Patients were brought to the operating room and placed under general anesthesia. In addition, 1% lidocaine with 1:100,000 epinephrine was injected under and around the lesions. We then removed the lesions with a Tricut laryngeal blade attached to a handheld powered shaver Postoperatively, patients were sent home on clindamycin, a pain medication, and Peridex. At the 1-week follow-up, patients reported only minimal pain, and their wounds were well healed. We observed no adverse events associated with the shaving procedure. Our method expedites the process of removing multiple oral cavity papillomas while reducing the morbidity generally associated with other procedures.
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PMID:Use of a powered shaver to remove multiple oral cavity papillomas. 1597 51

In the era of contemporary orthopaedics, haematology and internal medicine, it is obvious that surgery can be indicated in human immunodeficiency virus (HIV) and hepatitis C virus (HCV) coinfected haemophilia patients suffering from severe and painful musculoskeletal problems. However, the expected high risk of infection and other postoperative complications is a concern due to the poor health status that many of these patients present. In a HIV and HCV coinfected haemophilia patient, the orthopaedic surgeon together with the multidisciplinary haemophilia team should weigh the risks and benefits carefully. Clinical and immunological status should be considered before suggesting a surgical procedure (specially a joint arthroplasty) in this group of patients. If a surgical procedure is contraindicated, conservative treatment could be an alternative, although many times with inferior results. Usually, surgical procedures can better relieve pain for several years and improve the quality of life in this cohort of patients. Regarding anaesthetics, drugs metabolized by the liver or the kidney should be avoided depending on every particular case. Rachianaesthesia is more recommendable than epidural anaesthesia in elderly patients in whom general anaesthesia sometimes could be dangerous, although in all ages we prefer general anaesthesia. The size of the needle should be small (size G-27), and we never use spinal catheters.
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PMID:HIV and HCV coinfected haemophilia patients: what are the best options of orthopaedic treatment? 1668 2

Immunological parameters were studied at randomization in 60 surgical patients during the similar operation--cholecystectomy made under combined endotracheal low-flow general anesthesia using N2O:O2+fentanyl in 32 patients and Xe:O2 in 28 patients. The time course of changes in cellular immunity and cytokines was closely related to the type of an anesthetic. Unlike N2O:O2+fentanyl, Xe did not show such a marked proinflammatory activity, exerted a mild normalizing effect on leuko- and lymphopoiesis, had an immunostimulating activity, and reduced the frequency of postoperative inflammatory complications and the length of stay at hospital. The differences in the action of the anesthetics were due to the fact that Xe had a greater narcotic potential, a protective action on neuroendocrine function, and no toxicity. Xe is indicated to patients with baseline immunodeficiency.
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PMID:[Effect of anesthesia with xenon and nitrous oxide with fentanyl on dynamics of cellular immunity and cytokines]. 1675 35

In the light of increasing prevalence of the human immunodeficiency virus (HIV), anaesthetists are likely to see more patients with this virus in their practice. This study evaluated, using a questionnaire format, the knowledge, attitude and practices of anaesthetists in the management of HIV infected surgical patients. The questionnaire sought demographic information, the knowledge of risks involved as well as attitude and practices. One hundred (66.7%) out of 150 questionnaires distributed amongst members of the Nigerian Society of Anaesthetists were completed and returned. Fifty-five per cent (55%) of the respondents confirmed their willingness to be screened but only 45% had had a personal HIV screening test. Even though 23% of all the respondents will transfuse unscreened blood in an emergency, only 1(8.3%) of the consultants will do so. This trend was also reflected in gloving behaviour as 11(91.6%) of consultants will routinely wear gloves whilst only 12(70.5%) of the senior house officers will routinely glove for venepuncture despite the availability of gloves. Other precautionary facilities such as goggles, sharp disposal bins, routine screening of all surgical patients were more available in private than in government hospitals. Ninety- six per-cent of all respondents will initiate an action after a needle stick injury whilst 4% will ignore. General Anaesthesia was the choice of anaesthetic in an HIV/AIDS infected patient by 43% of respondents whilst 22% of respondents would choose regional technique. However, only 85% of respondents were willing to anaesthetise an infected patient. This study suggested a dearth of knowledge and perception of risks of HIV/AIDs amongst Nigerian Anaesthetists. Appropriate training and greater education is highly recommended. Rigorous infection control policy is imperative and hospital authorities must ensure availability of protective facilities.
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PMID:Knowledge, attitude and practices of Nigerian anaesthetists in HIV infected surgical patients: a survey. 1720 28


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