       Document 0851
 DOCN  M9540851
 TI    Parturients infected with human immunodeficiency virus and regional
       anesthesia. Clinical and immunologic response.
 DT    9504
 AU    Hughes SC; Dailey PA; Landers D; Dattel BJ; Crombleholme WR; Johnson JL;
       Department of Anesthesiology, University of California, San; Francisco.
 SO    Anesthesiology. 1995 Jan;82(1):32-7. Unique Identifier : AIDSLINE
       MED/95133729
 AB    BACKGROUND: It is estimated that 1.5 million Americans are infected with
       the human immunodeficiency virus (HIV-1), and the consequences of HIV
       infection are a leading cause of death in women aged 15-44 yr. Thus,
       HIV-1 disease, or acquired immunodeficiency syndrome, occurs with
       increasing frequency in the parturient, and there is little information
       concerning the risks of regional anesthesia. Fear of spreading infection
       to the central nervous system or adverse neurologic sequelae have led
       some clinicians to advise against regional anesthesia. Thus, this study
       was undertaken to evaluate the possible problems or risks associated
       with regional anesthesia in parturients infected with HIV-1 and to
       determine whether anesthesia affected the clinical course of the
       disease. METHODS: The clinical course and immunologic function of 30
       parturients infected with HIV-1 were evaluated prospectively. Extensive
       medical and laboratory evaluation before delivery and 4-6 months
       postpartum was undertaken. Medical problems related to HIV-1 disease and
       use of antiviral drugs also were monitored. The anesthetic management
       was dictated by the clinical situation and the patient's wishes were
       careful postpartum follow-up to evaluate possible neurologic changes or
       infection. RESULTS: Regional anesthesia was administered in 18
       parturients, and 12 received small doses of opioids or no analgesia.
       There were no changes in the immunologic parameters studied (CD4+, p24,
       beta 2 microglobulins), and HIV-1 disease remained stable in the
       peripartum period. There were no infections, complications, or
       neurologic changes in the peripartum period. Sixty-eight percent of the
       infants were HIV-1-negative and, in 21% of infants, the HIV-1 status was
       indeterminate (probably negative). CONCLUSIONS: This prospective study
       of parturients infected with HIV-1 demonstrated that regional anesthesia
       can be performed without adverse sequelae. There were no neurologic or
       infectious complications related to the obstetric or anesthetic course.
       The immune function of the parturient was stable in the peripartum
       period. Although the number of patients studied was small, with careful
       medical evaluation, regional anesthesia is an acceptable choice in the
       parturient infected with HIV-1.
 DE    *Acquired Immunodeficiency Syndrome/DRUG THERAPY/IMMUNOLOGY  Adult
       *Anesthesia, Conduction  *Anesthesia, Obstetrical  Female  Human
       Infant, Newborn  *Labor/IMMUNOLOGY  Pregnancy  *Pregnancy Complications,
       Infectious/DRUG THERAPY/IMMUNOLOGY  Pregnancy, High-Risk  Prospective
       Studies  Puerperium/BLOOD  Risk Factors  Support, Non-U.S. Gov't
       Support, U.S. Gov't, P.H.S.  Zidovudine/THERAPEUTIC USE  JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).

