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 preparations the preoperative knowledge, quantification, and treatment of HIV-associated opportunistic disorders and chronic organ damage are of particular importance. This requires an extended problem-orientated work-up. Furthermore, antiretroviral medication may interact with perioperatively ad-ministered pharmaceutics and lead to hardly foreseeable synergistic and antagonistic adverse effects, In contrast, "drug holidays" favor the development of HIV drug resistance, Operative Management: Anesthetic and surgical procedures basically depend on the underlying indication and consequently follow common principles, Laparoscopic techniques do not have any specific advantage in HIV-infected subjects. Preoperative Morbidity: During their postoperative course, HIV-infected patients have to be more often admitted to intensive care unit and kept on artificial respiration unplannedly, Perioperative morbidity of HIV-infected patients increases with the stage of their disease. It is, however, not significantly elevated compared to that of HIV-negative subjects in similar preoperative health condition.