AIDS and anaesthesia

From cholera to COVID-19: How pandemics have shaped the development of anaesthesia and intensive care medicine

The infectious pandemics and epidemics of the past 200 years have caused millions of deaths. However, these devastating events have also led to creative thinking, imaginative experimentation and the evolution of medical care. As a result, the history of critical care medicine is entwined with the story of these global disasters. This article will take case studies from recent pandemics and epidemics and examine their impact on the development of anaesthesia and intensive care medicine.

Anaesthesia and the child with HIV infection

The frequency of AIDS in the paediatric population is growing rapidly and is expected to get worse. The anaesthetist will participate in the care of these children in the operating room and the intensive care unit with increasing frequency and must therefore have an understanding of the many manifestations of this syndrome. Children become infected with HIV by transplacental transmission from mother to fetus in over 80% of cases. Early diagnosis in infants can be very difficult. Clinical manifestations of HIV infection in children result from damage to almost every organ system. Considerations for the anaesthetist include: the effects of medications, cardiovascular dysfunction, pulmonary disease, altered metabolism, equipment preparation, choice of anaesthetic, modes of viral transmission and psycho-social issues.

Anaesthesia and substance abuse

Current practices in the abuse of illicit drugs in the United Kingdom are described with particular reference to their pathological effects and the implications for anaesthesia. Practical guidelines are given for the anaesthetic and peri- and postoperative management of addicts.

The risk of infection in anaesthetic practice

Infectious hazards to anaesthesia personnel are real but the appropriate use of immunization, universal blood and body fluid precautions, and respiratory precautions where appropriate, should minimize the risk of infection at work. In particular, the resistance of physicians to immunization, especially to hepatitis B, needs to be changed. Protection against other blood-borne pathogens for which immunization is not available, such as HIV, may also depend on the willingness of anaesthesia personnel to accept and carry out recommendations for universal blood and body fluid precautions. Regulatory agencies and compensation boards are likely to look closely at adherence to established guidelines when determining benefits for work-related infections. Complaints that the routine use of gloves interferes with anaesthetic practice are frequent but unacceptable in the current climate and it behooves the profession to ensure that compliance with currently accepted infection control guidelines is complete.