Pre-existing neurological disease: how safe is regional anaesthesia?

Marcel Vercauteren MD, PhD
Department of Anaesthesia, University Hospital Antwerp, Belgiu

Abstract

Neurological disease, either unknown or diagnosed preoperatively, is a specific concern and challenge for anaesthetists. They need to consider the effect of anaesthesia on the disease, the influence of the disease on the course of anaesthesia, and the interaction of anaesthetic drugs with the medication taken by the patient.
As general anaesthesia requires more manipulation and different classes of drugs to be administered, it may be expected this affects the course of anaesthesia more significantly than regional techniques.
Although there is a lack of controlled studies, many anaesthetists, afraid of complaints, prefer to use general anaesthesia in cases of pre-existing neurological disease. Preoperative examination remains mandatory while patients should be informed about perioperative implications of anaesthesia, surgery and stress.
Paraesthesia, adrenaline and high concentrations of local anaesthetics should be avoided in the majority of diseases. Some diseases may benefit from epidural or peripheral anaesthesia, while for others a spinal technique may be the technique of choice. Spinal stenosis, mostly not known in advance, should receive special attention despite recent reports in favour of regional anaesthetic techniques.
Finally, too often anaesthetists take all the responsibility in the case of a progressive or new deficit in recovery after a surgical procedure, for which they have been a consultant.
Key words: neurological, neuromuscular, neurosurgery, anaesthesia, locoregional, complications

ACTUALIZĂRI

Jurnalul Român de Anestezie Terapie intensivă 2007, Vol.14, Nr.2, 103-110