Background:Creutzfeldt-Jakob disease(CJD) is a lethal dementia. It’s classified as a form of transmissible spongiform encephalopathy. Infective agents appear to be misshapen prion proteins resistant to sterilization currently used(1)Highest prion concentration occurs in neurological tissue(2) but contamination can occur in procedures that do not involve it(1)
Case Report:A 77 year-old male diagnosed of CJD with severe dementia was programmed for closed reduction of ankle dislocation. It was performed under sedation anesthesia and ventilatory facial mask support. Atropine was used to reduce oral secretions. Operating room(OR) was cleared of unnecesary equipment. Personal used ocular protection mask. Contact skin surfaces were covered in disposable plastic. After procedure all used equipment was placed in a burn bin including facial mask and disposable ventilator items.
Discussion:It’s a rare disease but due to their unusual resistance to standard decontamination methods and consequent risk of patient-patient transmission, management of infected patients requires additional precautions(2) OR should be cleared of unnecesary equipment and staffing reduced to the minimum. Single use disposable equipment should be used wherever practical. All surfaces that may be exposed to high-risk tissues must be covered in plastic, wich can then be incinerated. No evidence of infectivity of saliva or body secretions, but antisialogogues should be considered to reduce secretions(3). Specimens should be sent with a biohazard label, double-bagged and laboratories should be advised(2). The ventilator must be stripped of disposable circuits and filters, and these must be incinerated(3) At the end all single-use items, drapes, gowns, mask should be placed in a cytotoxic burn bin, that will be sealed, tagged and sent for incineration(3)
References:
1- M.C Blunt. Variant Creutzfeldt-Jakob disease and disposable anaesthetic equipment-balancing the risk. Br J Anaesth 2003;90
2- J. M. Tefler. Creutzfeldt-Jakob disease-implications for anaesthetists in New Zeland. Anaesth Intensive Care 2009;37: 386-391
3- P. Farling. Anaesthesia for patients with creutzfeldt jakob disease. A practical guide. Anaesth 2003;58:627-629
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Learning points:CJD is of clinical importance due to resistance of prion proteins to standard sterelisation(2)Planning appropriate anaesthetic include keep all techniques as simple as possible(3) Multidiscipplinary effort is required(3)

10 / A dangerous and unknown disease in the operating room: Creutzfeldt-Jakob