Perioperative shingles

[SexPanther]

80 y/o woman presents for pre-op eval prior to elective gynecologic surgery (anterior/posterior sling). Sparing all the other details, she has a herpes zoster outbreak x 14 days, currently nearing the end of her acyclovir treatment. The lesions have crusted over and she does not have known immunosuppression so she is most likely not contagious.

We decided to cancel the elective case until her zoster outbreak is completely healed but there really is no good evidence one way or another. Our thinking was that anesthetic agents can be immunosuppressive which could predispose to another, worse outbreak so why risk it.

Do any of you have experience, anectodotal or otherwise, with active herpes virus infections and timing of surgery?

Thanks.

---

Members don't see this ad.

 

[Idiopathic]

i guess the debate is over whether the imunosuppressive effects of anesthesia will be worse in the convalescent phase of the disease than in the chronic phase, i.e. will it be more likely to recur now or in 3 months. my intuition says theres no difference, but i dont have hard evidence.

could do the case under combined spinal epidural with precedex and lidocaine drips

 

[Planktonmd]

could do the case under combined spinal epidural with precedex and lidocaine drips

Why is that better than general anesthesia for this patient?

 

[SexPanther]

Why is that better than general anesthesia for this patient?

Inside joke plank.

 

[Idiopathic]

it is somewhat of an inside joke, but if yuo believe that volatile agents and propofol/opioids suppress the immune response enough to cause recurrence of shingles then this wouldnt be the worst idea