3. Electronic Theses and Dissertations (ETDs) - All submissions

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    Time until first analgesic requirement, post caesarean section under spinal anaesthesia, in HIV-positive patients at Chris Hani Baragwanath Hospital
    (2011-10-11) Wagner, Janine Louise
    BACKGROUND Multiple studies have been conducted comparing the efficacy and duration of analgesia obtained from spinal anaesthesia containing local anaesthetics as well as opioids. The literature available has not considered the individual‟s HIV status as a variable. Postoperative analgesic duration and requirements in this group of patients may differ due to the occurrence of acute and chronic pain syndromes, pain arising from the disease itself, side effects of treatment for HIV infection, or opportunistic infections. Response to opioid analgesia may be altered due to previous opioid exposure, potential increase in nociception, drug interactions and emotional status. OBJECTIVES The primary objective of this study was to determine the time to post-operative analgesic request in HIV-positive and negative individuals having caesarean sections under spinal anaesthesia containing bupivacaine or bupivacaine and fentanyl. The secondary objectives of this study were to determine if factors such as height, ethnicity, level of education, CD4 count, and antiretroviral therapy impacted on the duration of analgesia obtained.
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    Preoperative clinical status in HIV-positive patients presenting for anaesthesia, and the correlation with the CD4-count
    (2009-11-11T13:37:39Z) Penfold, Phillipa Rae
    BACKGROUND HIV infection is common in South Africa. The disease often remains clinically latent, despite the patient having severe immune compromise. Clinical preoperative assessment may result in patients with this severe systemic disease going unnoticed. OBJECTIVES The primary objective was to determine the relationship between the preoperative physical status of HIV-positive patients presenting for anaesthesia and the CD4- count. The secondary objectives were to determine the prevalence of HIV infection in this group of patients, to determine the prevalence of HIV infection in selected subgroups, to ascertain what proportion of patients presenting for anaesthesia know their HIV status, and to ascertain what proportion of HIVpositive patients are receiving highly active antiretroviral therapy (HAART). METHOD A sample of 350 adult patients presenting for anaesthesia at Chris Hani Baragwanath Hospital was selected. Patients were interviewed preoperatively and were examined, and in doing so their ASA physical status grading was determined. Blood was sampled, and in those who were confirmed HIV-positive, vi a CD4-count was checked. Further data were collected: age, gender, the type, nature, urgency and time of day of surgery, the patient’s knowledge of their HIV status, and whether the patient was receiving HAART or not. RESULTS HIV-positive patients were more likely to be classified as ASA 1 or 2 than ASA 3 or 4 (OR 2.1). HIV-positive patients with CD4-counts above 200 cells.mm-3 were also more likely to be ASA 1 or 2 than ASA 3 or 4 (OR 3.88). However, within the group of HIV-positive patients with CD4-counts below 200 cells.mm-3, significantly more patients were classified as ASA 1 or 2 than ASA 3 or 4 (p<0.0001). Three patients with CD4-counts below 50 cells.mm-3 were classified as ASA 1 or 2. The overall prevalence of HIV infection was 29.4%. Within the various subgroups, the groups with higher disease prevalence rates were females, patients presenting for obstetric surgery, and the younger age groups. The highest prevalence of HIV infection was found in patients aged 30-39 years (43.0%), and the lowest prevalence was found in patients aged 60 years or older (7.7%). CONCLUSIONS Routine clinical preoperative assessment in patients from a population with a high HIV prevalence rate may result in asymptomatic, severe immune compromise secondary to HIV infection being missed in a significant number of patients. Further study into the perioperative outcomes of these patients is warranted.
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