Regional Anesthesia in the Presence of Neurologic Disease

Chapter

Key Points

  • Most anesthesiologists are very cautious about the use of regional anesthesia in patients with neurologic disease, mainly because of the medical legal risk. Lawyers seem to have more success linking the exacerbation of neurologic disease following regional anesthesia, than that following general. In truth we really do not have sufficient data to determine which technique is more likely to cause an exacerbation of neurologic disease. Therefore the choice of anesthetic technique should be based primarily on the preoperative assessment of the patient. As always, a thorough consideration of the risks and benefits should be performed for each patient.

  • A number of reports describe successful regional anesthesia in individuals suffering from multiple sclerosis, including obstetric patients. However, practitioners should be aware of other cases in which exacerbation of symptoms or relapse has occurred following anesthesia administration.

  • Regional anesthesia can be used for individuals with spinal cord injuries, but this can be challenging and may require use of adjunct technologies such as nerve stimulation or ultrasound. Similarly, regional blocks have been performed successfully in patients with peripheral neuropathy, but unique risks, such as hemodynamic instability in diabetic individuals, must be considered.

  • A complete neurologic exam is required for all patients with preexisting neurologic disease regardless of the choice of anesthetic technique and this information must be carefully recorded in the patient’s medical record.

Keywords

Neurologic disease Regional anesthesia Multiple sclerosis Myasthenia gravis Polio/Post-polio syndrome Amyotrophic lateral sclerosis Muscular dystrophies Dystrophia myotonia Spinal cord injury Peripheral nerve injury 

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Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Department of AnesthesiaUniversity of Wisconsin MadisonMadisonUSA
  2. 2.Department of Intensive CareThe Austin HospitalHeidelbergAustralia
  3. 3.Department of SurgeryThe Austin HospitalHeidelbergAustralia

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