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[Anesthetic regimen for HIV positive parturients undergoing elective cesarean section]
D H Bremerich1, A Ahr, S Büchner
1Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Klinikum der Johann Wolfgang Goethe-Universität Frankfurt, Frankfurt. Bremerich@em.uni-frankfurt.de
Der Anaesthesist
|December 24, 2003
Summary
This study found that spinal anesthesia with mepivacaine and sufentanil is a safe option for Cesarean deliveries in women with human immunodeficiency virus (HIV). Neonatal outcomes were positive, with a low HIV transmission rate of 1.8%.
Area of Science:
- Anesthesiology
- Obstetrics
- Infectious Diseases
Background:
- Human immunodeficiency virus (HIV) affects 50 million globally, with 43% being women.
- Perinatal vertical transmission is the primary cause of new pediatric HIV cases.
- Strategies like Cesarean delivery and antiretroviral therapy reduce transmission, but perioperative maternal and neonatal morbidity data are limited.
Purpose of the Study:
- To prospectively record perioperative maternal and neonatal complications.
- To evaluate the safety and efficacy of spinal anesthesia in HIV-positive women undergoing Cesarean section.
- To assess the largest cohort to date for this specific patient group.
Main Methods:
- 54 HIV-positive parturients underwent elective Cesarean section between 1999-2001.
- Intravenous zidovudine therapy was administered perioperatively.
- Spinal anesthesia utilized 60 mg of 4% hyperbaric mepivacaine with 5 microg sufentanil intrathecally.
Main Results:
- 65% of parturients experienced short-term hypotension.
- Postoperative complications occurred in 17%, primarily wound healing impairment and respiratory infections.
- After an 8-month follow-up, only one infant (1.8%) tested HIV positive.
Conclusions:
- Intrathecal mepivacaine and sufentanil provide an appropriate anesthetic option for HIV-positive women during Cesarean delivery.
- Postoperative maternal morbidity was observed in 17% of cases.
- No evidence of neonatal depression was noted, and vertical HIV transmission was minimal.