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Year : 2023  |  Volume : 17  |  Issue : 1  |  Page : 140-141

Ten facts about monkeypox that every anesthesiologist should know

1 Department of Anesthesiology and Critical Care, AIIMS, Jodhpur, Rajasthan, India
2 Department of Trauma and Emergency (Anesthesiology), AIIMS, Jodhpur, Rajasthan, India

Correspondence Address:
Ankur Sharma
58, Subhash Nagar -2, Jodhpur - 342 008, Rajasthan
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/sja.sja_549_22

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Date of Submission26-Jul-2022
Date of Decision27-Jul-2022
Date of Acceptance27-Jul-2022
Date of Web Publication02-Jan-2023

How to cite this article:
Das AK, Sharma A, Kothari N, Goyal S. Ten facts about monkeypox that every anesthesiologist should know. Saudi J Anaesth 2023;17:140-1

How to cite this URL:
Das AK, Sharma A, Kothari N, Goyal S. Ten facts about monkeypox that every anesthesiologist should know. Saudi J Anaesth [serial online] 2023 [cited 2023 Mar 31];17:140-1. Available from:

After a slight recovery from the Coronavirus disease 2019 (COVID-19) pandemic, another pandemic is now at the doorstep of the world health prospectus, that is, monkeypox. Monkeypox disease is transmitted by the double enveloped DNA virus from the Orthopoxvirus genus and Poxviridae family.

The first case was identified from a group of laboratory monkeys in Copenhagen, Denmark, in 1952; there was a gap of 12 years after which the first case in humans was identified in the Democratic Republic of Congo.[1] Western countries were less bothered and concerned about this endemic disease of Africa until this current outbreak.

Monkeypox has already been declared by the World Health Organization (WHO) a Public Health Emergency of International Concern (PHEIC) on July 23, 2022.[2] Until July 25, 2022, there was a total of 18,095 monkeypox cases from 75 countries.

The symptoms consist of fever, headache, prostration, myalgia, chills, and atypical rash, which are commonly seen in the genital region or anal area and spread to the palm, sole, and chest with different stages of development. However, in severe cases, there can be pneumonia, central nervous system infection, and multiorgan failure.

The natural reservoir of monkeypox is still unknown. The monkeypox virus is transmitted when there is close contact with the infected animal, human, or fomites through the respiratory tract, mucus membrane, and when there is a breach in the skin. Human-to-human transmission is mostly through respiratory droplets, and another mode of spread is through direct contact with body fluids, lesions, and used clothes.

The anesthesiologist should be aware of the probable implication of monkeypox regarding the perioperative management of the patient posted for any emergency surgical procedure and about the timing of the elective surgical procedure. The following points are highlighted.

  1. Elective surgery could be postponed until the healing of the skin lesion such as chicken pox though there is no clear-cut guideline.
  2. As the incubation period may be prolonged up to 2 weeks, any contact with a confirmed case of monkeypox can be denied for elective surgery until 2 weeks after contact.
  3. As with the previous COVID-19 epidemic, dedicated operation theatre and manpower are to be recruited from the main pool when there is a rising number of monkeypox cases.
  4. Education of staff regarding personal precaution by using personal protective equipment (PPE) kit and its disposal and sterilization of equipment.
  5. The anesthesiologist should be aware of the signs, symptoms, clinical criteria for diagnosis of confirmed and probable monkeypox cases, and differentiation of skin lesions with other diseases with the rash.
  6. As the disease is transmitted through close contact and droplets, care should be taken during the bag-mask procedure, intubation, and extubating of the patient. Precautions and guidelines regarding airway management similar to the COVID-19 pandemic could be utilized in these cases with no bag-mask ventilation, rapid sequence intubation, and use of a video-laryngoscope.
  7. The type of anesthesia, either general anesthesia or spinal anesthesia, has advantages and disadvantages. Gambling recommended regional anesthesia as the preferred choice in acute varicella-zoster virus (VZV) due to the risk of varicella pneumonia.[3] Similarly, this can be true for monkeypox also.
  8. Due to the widespread skin lesion, precautions should be taken during regional anesthesia and peripheral nerve blocks. There is a risk of spreading epithelial cells in intrathecal and epidural spaces with hollow spinal needles and viral translocation to the central nervous system.[4]A pencil tip spinal needle could be an alternative.[5]
  9. As patients with monkeypox may have painful skin lesions and may have been previously treated with opioid analgesics, a higher analgesic dosage may be warranted.
  10. Anti-viral drugs used for smallpox could interact with anesthesia drugs. The anesthesiologist should be aware of these drug interactions.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Parker S, Buller RM. A review of experimental and natural infections of animals with monkeypox virus between 1958 and 2012. Future Virol 2013;8:129-157.  Back to cited text no. 1
Who. int. 2022. WHO Director-General declares the ongoing monkeypox outbreak a Public Health Emergency of International Concern. Available from: <>. [Last accessed on 2022 Jul 26].  Back to cited text no. 2
Gambling DR. Obstetric Anesthesia and Uncommon Disorders. 2nd ed. United Kingdom (UK): Cambridge University Press; 2008.  Back to cited text no. 3
McDonald JV, Klump TE. Intraspinal epidermoid tumors caused by lumbar puncture. Arch Neurol 1986;43:936-9.  Back to cited text no. 4
Brown NW, Parsons AP, Kam PC. Anesthetic considerations in a parturient with varicella presenting for Caesarean section. Anesthesia 2003;58:1092-5.  Back to cited text no. 5


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