Department of Anesthesia, National University Hospital, Singapore, Singapore.
Department of Anesthesia, National University Hospital, Level 3, Main Building, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore.
Can J Anaesth. 2023 May;70(5):893-900. doi: 10.1007/s12630-023-02441-2. Epub 2023 Mar 10.
Monkeypox (or "mpox" as preferred by the World Health Organization) is an emerging infectious disease with sustained global transmission occurring outside of West Africa and the Democratic Republic of Congo. The recent 2022 mpox outbreak has involved widespread atypical presentations. Infected patients requiring surgery can increase the exposure of health care professionals and other patients to the virus. As it is a relatively new infectious disease internationally, there is less familiarity in managing this risk, especially in the surgical and anesthesia setting. This paper aims to provide information about mpox and how to manage suspected or confirmed cases.
Various authorities such as the World Health Organization, Infection Prevention and Control Canada, Public Health Agency of Canada, the Centers for Disease Control and Prevention (USA), and the National Centre for Infectious Diseases (Singapore) have recommended that public health and hospital systems prepare to recognize, isolate, and care for suspected and confirmed cases appropriately, as well as manage any possible exposure of staff and patients.
Local authorities and hospitals should set up protocols for health care providers (HCPs) to minimize nosocomial transmission and risk to HCPs. Antivirals used in patients with more severe disease may cause renal or hepatic impairment and thus anesthetic drug pharmacology. Anesthesiologists and surgeons should be able to recognize mpox, and work with local infection control and epidemiologic programs to familiarize themselves with relevant infection prevention guidelines.
Essential measures include clear protocols for transferring and managing surgical patients who are suspected or confirmed to be infected with the virus. Care in use of personal protective equipment and handling contaminated material is necessary to prevent inadvertent exposure. Risk stratification after exposure should be done to determine need for post-exposure prophylaxis for staff.
猴痘（世界卫生组织更倾向于使用“mpox”一词）是一种新发传染病，其在西非和刚果民主共和国以外的地区持续发生全球传播。最近 2022 年的 mpox 暴发涉及广泛的非典型表现。需要手术的感染患者会增加医护人员和其他患者暴露于病毒的风险。由于这是一种在国际上相对较新的传染病，因此在管理这种风险方面的熟悉程度较低，尤其是在手术和麻醉环境中。本文旨在提供有关 mpox 的信息以及如何管理疑似或确诊病例。
世界卫生组织、加拿大感染预防和控制机构、加拿大公共卫生署、美国疾病控制和预防中心（美国）以及新加坡国家传染病中心等各种权威机构都建议公共卫生和医院系统做好准备，以便适当地识别、隔离和照顾疑似和确诊病例，并管理工作人员和患者可能发生的任何暴露。
地方当局和医院应制定卫生保健提供者（HCPs）的协议，以最大程度地减少医院内传播和 HCPs 的风险。用于治疗病情较重患者的抗病毒药物可能会导致肾或肝损伤，从而影响麻醉药物的药理学。麻醉师和外科医生应能够识别 mpox，并与当地感染控制和流行病学计划合作，熟悉相关感染预防指南。
基本措施包括明确的协议，用于转移和管理疑似或确诊感染病毒的手术患者。在使用个人防护设备和处理污染材料时应谨慎，以防止意外暴露。应进行接触后风险分层，以确定工作人员是否需要进行接触后预防。
