Anaesthetic considerations for patients with a pre‐existing neurological deficit: are neuraxial techniques safe?

Abstract

Pre-existing neurological and muscular disease may be a specific concern for anaesthetists as they need to consider the effect of anaesthesia upon the disease, vice versa, and the interaction of anaesthesia with the medication taken by the patient. Despite a lack of controlled studies, many anaesthetists, being afraid of a claim, will prefer general rather than regional anaesthesia in these patients. Nevertheless regional anaesthesia certainly merits its place because it offers undeniable advantages. A good pre-operative examination is very important while patients should also be informed about peri-operative implications of anaesthesia, surgery and stress. Paraesthesias, epinephrine and high concentrations of local anaesthetics should be avoided in the majority of the diseases. Some diseases may benefit from epidural anaesthesia while for others a spinal technique may be the technique of preference. Special attention should be paid to patients with spinal stenosis despite recent reassuring reports with respect to safety of regional anaesthetic techniques. Anaesthetists should not automatically take all responsibility in case of progressive or new deficit after the procedure.

Epidural blood patch in a patient with multiple sclerosis: is it safe?

“…14 The ''middle latency'' P40 response to electrical stimulation of the tibial nerve reflects conduction through peripheral nerves, spinal cord, and cortex. 14,15 With the patient described in this report, all P40 response latencies fell just outside the mean range of published normal values, consistent with the interference of axonal conduction associated with MS. 15,16 The 4.6 msec latency difference of P40 responses recorded just prior to and following EBP is actually smaller than left-vs rightsided values in MS patients showing unilateral signs and symptoms of their disease. 15,16 Moreover, eight days following the EBP, the P40 latencies of 47.8 msec and 43.8 msec (D 3.5 msec) were recorded during the same session.…”

“…15,16 Moreover, eight days following the EBP, the P40 latencies of 47.8 msec and 43.8 msec (D 3.5 msec) were recorded during the same session. With these considerations in mind and the wellknown variability of responses observed even in stable patients, 14 we consider that the EBP did not significantly alter evoked somatosensory responses and, by analogy, any increase in epidural pressure had no physiological consequence with respect to axonal conduction. This view is also supported by the clinical observation that resolution of postdural puncture symptoms following the EBP was not accompanied by deterioration in motor or sensory function.…”

Obstetric anesthesia/analgesia does not affect disease course in multiple sclerosis: 10‐year retrospective cohort study

“…These results support the idea that epidural anesthesia seems to involve less risk because local anesthetic reaches the intrathecal space in lower concentrations than intrathecal administration in spinal anesthesia (Stoelting & Dierdorf, 1993). Recommendations have been made to limit neuraxial dosing to the lowest level to achieve adequate pain management in all patients during labor and birth (Lirk et al., 2011) and to avoid paresthesia or epinephrine (Vercauteren & Heytens, 2007). Local anesthetics may directly interact with MS lesions and temporarily worsen symptoms by blocking sodium channels in demyelinated spinal areas (Lirk et al., 2011).…”

“…Recent data show that increased postnatal relapse rates seem to be the only real risk for these women (Finkelsztejn et al., 2011), irrespective of the type of anesthesia (Hinova & Fernando, 2010). Anesthetists should not automatically take all the responsibility in the case of progressive or new deficits after the procedure (Vercauteren & Heytens, 2007). …”

General Anaesthesia in Patients With Cerebrovascular Diseases - Risks and Complications

“…It is an occlusive cerebrovascular disease manifested through ischemia or cerebral hemorrhage. This disease may be accompanied by intracranial aneurysms (Vercauteren, Heytens 2007). The treatment is conducted through the application of vasodilators, anticoagulant and antiplatelet drugs as well as surgery.…”