Prion‐related diseases and anaesthesia

Prion-related disorders such as CJD, fatal familial insomnia, and Gerstmann–Strauss–Scheinker disease result from mutations in the native prion protein gene PRNP. The mutations alter the amino acid sequence and three-dimensional shape of the cellular native prion protein (PrPC) leading to the infectious form of the protein (PrPSC). The PrPSC in turn catalyses the aggregation of existing PrPC into amyloid plaques [1]. The PrPSC occur most commonly in the central nervous system, appendix and lymphoreticular tissues. The precise structure of the transmissable agent, the mechanism of neurodegeneration and the risk of transmission of these PrPSC are currently unknown. Unlike existing pathogenic agents such as viruses or bacteria, infectious PrPs are resistant to inactivation by radiation, heat or harsh chemical treatments [2]. In response to the possible risk of nosocomial transmission of variant Creutzfeldt–Jacob disease (vCJD) and other prion-related disorders through surgical instruments, the government made £200 million available for the modernisation of the National Health Service (NHS) decontamination and sterilisation facilities and recommended the introduction of single-use surgical instruments for tonsillectomy during 2001 [3]. Anaesthetists are exposed on a daily basis to the lymphoreticular tissues of the upper airway. Reusable instruments, such as the laryngeal mask airway and laryngoscopes, which are either autoclaved or simply cleaned [4], are common practice. The move towards disposable surgical instruments for ‘high-risk’ surgery should alert anaesthetists especially in the UK to the theoretical risk of iatrogenic transmission of prion-related diseases from reusable anaesthetic instruments. Consideration should be given to future use of disposable laryngoscopy blades and laryngeal mask airways.