Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content ++ Autoimmune disease characterized by antibody-mediated demyelination in central nervous system, which leads to impaired nerve conduction. Peripheral nerves are not involvedCombination of genetic and environmental factors2F/1MAge of onset usually 20–40, but can be seen at any ageSigns and symptoms related to site of CNS affected by demyelinationBroad spectrum—relapses and remissions, or chronic and progressiveVariety of triggers, such as stress and heat (fever)Many signs and symptoms are possible, but more commonly seen are visual symptoms from optic nerve involvement, skeletal muscle/spasms from spinal cord involvement, bowel/bladder dysfunction, lack of coordination, paresthesias, seizures, depression, autonomic disturbances in advanced disease. Lower extremities more frequently involved than upper extremitiesDiagnosis usually based on cerebrospinal fluid antibodies or magnetic resonance imagingMS patients can be treated with a wide variety of medications, some targeting the disease and some targeting specific symptoms:Treatment with corticosteroids, interferons (Avonex, Betaseron, Rebif), glatiramer (Copaxone), azathioprine (Imuran), mitoxantrone (Novantrone; cardiotoxic), natalizumab (Tysabri), cyclophosphamide (Cytoxan), and methotrexateSymptomatic treatment with baclofen (lioresal), tizanidine (Zanaflex) for muscle spasms, cholinergic medications for urinary symptoms, or antidepressants for mood disturbances ++ Thorough history with careful attention to history of relapses, remissions, triggers, typical complaints, and symptoms during exacerbationsComplete list of medications should be reviewed prior to induction to delineate any potential interactions with anesthetic medicationsElicit steroid use and potential for adrenal suppressionPreoperative neurologic exam with focus on visual symptoms as well as skeletal muscle weakness should be performed to establish a baselineElective surgery should not be performed during periods of relapse ++ Exacerbations during the perioperative period are possible due to surgical stress, regardless of anesthetic technique or medicationsSuccinylcholine is best avoided due to possibility of increased potassium releaseNondepolarizing NMB: both increased sensitivity and resistance have been described; judicious use with peripheral nerve stimulator is recommendedStress-dose steroids if indicatedIncreased temperature can precipitate symptoms, monitor body temperature; avoid hyperthermiaSpinal anesthesia may increase risk of postoperative exacerbations, maybe because the demyelination makes the CNS more sensitive to LA neurotoxicity, but epidural and peripheral nerve block techniques appear safeNo evidence that general anesthesia drugs, either injected or inhaled, exacerbate MSAutonomic dysfunction should be taken into consideration when monitoring hemodynamics and during fluid management ++ Reassess neurologic statusLook for evidence of relapses, and assess for presence of any potential triggers that may be present in the postoperative environmentExercise vigilance with respect to postoperative temperature controlCommunication with surgeon, neurologist, and primary care physician is essentialBaclofen withdrawal can occur, especially if long-standing therapy, with neuropsychiatric symptoms (hallucinations, anxiety, tremor), and possibly seizures, or even muscle rigidity and hyperthermia resembling neuroleptic malignant syndrome ++ Perform both a thorough history of disease progression and neurologic exam prior to surgerySpinal anesthesia may increase risk of postoperative exacerbations, but no evidence that general anesthesia, epidural, or PNB exacerbates MSAvoid hyperthermiaPlatelet aggregation is increased in MHIncreased risk of ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.