Preoperative risk assessment and perioperative management of HIV-infected patients

Problem: Due to their impaired immune function, unusual multimorbidity, and extensive concomitant medication HIV-infected patients impose special and specific demands on those who deal with their perioperative care. Pre-operative Assessment: Beside standardized diagnostic and therapeutic pr eparations the preoperative knowledge, quantification, and treatment of HIV -associated opportunistic disorders and chronic organ damage are of particu lar importance. This requires an extended problem-orientated work-up. Furth ermore, antiretroviral medication may interact with perioperatively ad-mini stered pharmaceutics and lead to hardly foreseeable synergistic and antagon istic adverse effects, In contrast, "drug holidays" favor the development o f HIV drug resistance, Operative Management: Anesthetic and surgical procedures basically depend o n the underlying indication and consequently follow common principles, Lapa roscopic techniques do not have any specific advantage in HIV-infected subj ects. Preoperative Morbidity: During their postoperative course, HIV-infected pat ients have to be more often admitted to intensive care unit and kept on art ificial respiration unplannedly, Perioperative morbidity of HIV-infected pa tients increases with the stage of their disease. It is, however, not signi ficantly elevated compared to that of HIV-negative subjects in similar preo perative health condition.