Neuraxial anesthesia in patients with multiple sclerosis – a systematic review

Bornemann‐Cimenti, Helmar; Sivro, Nikki; Toft, Frederike; Halb, L.; Sandner‐Kiesling, Andreas

doi:10.1016/j.bjane.2016.09.001

Cited by 12 publications

(8 citation statements)

References 44 publications

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“…Concern regarding associations between spinal anesthesia and MS relapses emerged almost 70 years ago. 180 Since then, prospective studies and a meta-analysis have demonstrated the safety of spinal anaesthesia in MS. 5,81,181,182 The American Society of Regional Anesthesia and Pain Medicine states in its 2015 guidelines that epidural anesthesia is considered safer than spinal anesthesia because it does not deposit local anesthetic directly adjacent to the CNS. 183 However, choice of analgesia in labor is best left to discretion of the obstetrician and anesthesiologist in discussion with the woman.…”

Section: Obstetric Managementmentioning

confidence: 99%

Sex effects across the lifespan in women with multiple sclerosis

Krysko

Graves

Dobson

et al. 2020

Ther Adv Neurol Disord

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Multiple sclerosis (MS) is an autoimmune inflammatory demyelinating central nervous system disorder that is more common in women, with onset often during reproductive years. The female:male sex ratio of MS rose in several regions over the last century, suggesting a possible sex by environmental interaction increasing MS risk in women. Since many with MS are in their childbearing years, family planning, including contraceptive and disease-modifying therapy (DMT) counselling, are important aspects of MS care in women. While some DMTs are likely harmful to the developing fetus, others can be used shortly before or until pregnancy is confirmed. Overall, pregnancy decreases risk of MS relapses, whereas relapse risk may increase postpartum, although pregnancy does not appear to be harmful for long-term prognosis of MS. However, ovarian aging may contribute to disability progression in women with MS. Here, we review sex effects across the lifespan in women with MS, including the effect of sex on MS susceptibility, effects of pregnancy on MS disease activity, and management strategies around pregnancy, including risks associated with DMT use before and during pregnancy, and while breastfeeding. We also review reproductive aging and sexual dysfunction in women with MS.

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Section: Obstetric Managementmentioning

confidence: 99%

Sex effects across the lifespan in women with multiple sclerosis

Krysko

Graves

Dobson

et al. 2020

Ther Adv Neurol Disord

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“…The emergence of more extensive prospective studies leads to more favourable results and an increased exposure to local analgesia/anaesthesia. 7,60,[70][71][72] Except for one study, it is unclear whether women received locoregional analgesia or anaesthesia. There is no increased risk of relapse in the PP associated with local analgesia/anaesthesia.…”

Section: Resultsmentioning

confidence: 99%

Pregnancy and multiple sclerosis: 2022 recommendations from the French multiple sclerosis society

Vukusic

Ciron²,

Maillart

et al. 2022

Mult Scler

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Objective: The objective of this study was to develop evidence-based recommendations on pregnancy management for persons with multiple sclerosis (MS). Background: MS typically affects young women in their childbearing years. Increasing evidence is available to inform questions raised by MS patients and health professionals about pregnancy issues. Methods: The French Group for Recommendations in Multiple Sclerosis (France4MS) reviewed PubMed and university databases (January 1975 through June 2021). The RAND/UCLA appropriateness method was developed to synthesise the scientific literature and expert opinions on healthcare topics; it was used to reach a formal agreement. Fifty-six MS experts worked on the full-text review and initial wording of recommendations. A group of 62 multidisciplinary healthcare specialists validated the final proposal of summarised evidence. Results: A strong agreement was reached for all 104 proposed recommendations. They cover diverse topics, such as pregnancy planning, follow-up during pregnancy and postpartum, delivery routes, locoregional analgesia or anaesthesia, prevention of postpartum relapses, breastfeeding, vaccinations, reproductive assistance, management of relapses and disease-modifying treatments. Conclusion: The 2022 recommendations of the French MS society should be helpful to harmonise counselling and treatment practice for pregnancy in persons with MS, allowing for better and individualised choices.

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“…[12] Regional anesthesia techniques are not contraindicated; however, they are not completely safe. [13] Lower prevalence of hypotension in epidural anesthesia may be preferred instead of spinal anesthesia. [14] Kyatta et al [15] examined the association between the perioperative findings of 56 cases with MS and the anesthetic technique used and reported that they have encountered hypotension refractory to intravenous vasopressor treatment in 4 patients who received regional anesthesia in the form of spinal (n=2) and epidural anesthesia (n=2).…”

Section: Discussionmentioning

confidence: 99%

Anesthesia management and using sugammadex in a pregnant patient with multıple sklerosis

2018

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The aim of the present study was to discuss the management of anesthesia in our case with multiple sclerosis (MS) and to present the effects of sugammadex administration. A 36-year-old pregnant patient with MS disease was followed up for 6 years. She was on steroid treatment. The patient had not suffered the entire pregnancy. In addition to performing routine monitoring, "train of four" (TOF) monitorization was used. General anesthesia was given using propofol and rocuronium. At the end of the operation, muscle relaxation was reversed using sugammadex in the patient with a low TOF score. The patient was discharged on postoperative day 3. The most reliable method should be preferred in patients with MS. In patients under general anesthesia, the muscle relaxant effect is prolonged, and sugammadex can be safely used.

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Neuraxial anesthesia in patients with multiple sclerosis – a systematic review

Cited by 12 publications

References 44 publications

Sex effects across the lifespan in women with multiple sclerosis

Sex effects across the lifespan in women with multiple sclerosis

Pregnancy and multiple sclerosis: 2022 recommendations from the French multiple sclerosis society

Anesthesia management and using sugammadex in a pregnant patient with multıple sklerosis

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