Desflurane anaesthesia in a patient with multiple sclerosis in total hip replacement

Abstract

Multiple sclerosis (MS) is a progressive demyelinating disease presenting with a relapsing-remitting course and affects large areas of the brain and the spinal cord. Surgical stress often induces exacerbation of MS symptoms. It is mandatory to prepare the MS patient very carefully for the surgery and anaesthesia with an effective premedication and an effective postoperative analgesia following a safe and minimal-risk anaesthesia management. In recent reports, results of general and regional anaesthesia in MS patients have been discussed. To our knowledge this is the first case report of the use of desflurane anaesthesia in a patient with MS. In conclusion, desflurane anaesthesia is a safe and useful method for MS patients.

Use of rocuronium and sugammadex under neuromuscular transmission monitoring in a patient with multiple sclerosis

“…Since the demyelinated neural tissue is sensitive and susceptible to local anesthetic toxicity, epidural anesthesia may probably be preferred over spinal due to the lower drug concentrations that develop in the spinal cord. Among IV anesthetics, propofol,[2345] thiopental,[6] and etomidate[7] have been safely used for anesthesia induction. Similarly, most volatiles, namely, halothane,[4] isoflurane,[6] sevoflurane,[2358] and desflurane[7] have been used uneventfully for the maintenance of anesthesia, with the latter two agents being associated with fast and smooth emergence.…”

“…Similarly, most volatiles, namely, halothane,[4] isoflurane,[6] sevoflurane,[2358] and desflurane[7] have been used uneventfully for the maintenance of anesthesia, with the latter two agents being associated with fast and smooth emergence. [78] Moreover, sevoflurane was administered for both anesthesia induction and maintenance in a patient with MS exacerbation. [9] Opioid analgesia with fentanyl[2348] or remifentanil[357] has been used without complications, apart from chest wall rigidity - without further sequelae - observed in a spontaneously breathing patient receiving remifentanil infusion.…”

“…[78] Moreover, sevoflurane was administered for both anesthesia induction and maintenance in a patient with MS exacerbation. [9] Opioid analgesia with fentanyl[2348] or remifentanil[357] has been used without complications, apart from chest wall rigidity - without further sequelae - observed in a spontaneously breathing patient receiving remifentanil infusion. [5] Since case reports represent the main source of information, there is no strong evidence regarding the optimal general anesthetic for patients with MS.…”

Anesthetic Management of a Patient With Multiple Sclerosis

“…Literature on the most appropriate method of general anesthesia in MS is generally limited to case reports and describe the role of stress and anesthesia in inducing exacerbations of central nervous system symptoms. [2][3][4][5][6] However, many clinicians believe that general anesthesia causes fewer exacerbations and is superior to neuraxial techniques. 1 Surgical procedures can affect physical condition when the state of MS is unstable.…”

“…[1][2][3][4][5][6] In these patients, resistance to nondepolarizing neuromuscular blocking agents may develop due to increased number of acetylcholine receptors produced by denervation. 5 In addition, muscle weakness and decreased muscle mass are associated with increased sensitivity to neuromuscular blocking agents.…”