Multiple sclerosis (MS) is a rare autoimmune demyelinating disorder of the central nervous system clinically manifesting as periodic attacks of varied neurologic symptoms, eventually progressing to fixed neurologic deficits and disability. The treatment is symptomatic and directed towards prevention of future progression of the disease involving multiple agents. We present here a case report of a patient with MS who underwent an orthopaedic procedure under general anaesthesia (G.A.) uneventfully. Anaesthetic implications include assessment of neurological deficits with documentation pre- and postoperatively, awareness towards side-effects, potential drug interactions of medications, selection of suitable techniques/anaesthetic agents, neuromuscular monitoring-guided titration of non-depolarizing blocking agents with lowest necessary dose and avoidance of hyperthermia along with temperature, haemodynamic and respiratory monitoring. Lower concentrations of local anaesthetic (LA) should be used for regional blocks keeping in mind the susceptibility of demyelinated neurons, towards LA neurotoxicity. To the best of our knowledge, this is the first report of anaesthetic management of MS in India.
Prader willi syndrome (PWS) is a complex multisystem disorder. PWS mainly affects central nervous system and often involves the hypothalamus. Its major clinical features include neonatal hypotonia, developmental delay, short stature, behavior abnormalities, childhood onset obesity, hypothalamic hypogonadism and characteristic appearance. Anaesthetic management with general or regional anaesthesia for these patients is difficult mainly due to morbid obesity. The importance of PWS for anesthesiologist and primary physician is estimated by the circumstances as the prevalence of PWS is nearly as frequent as trisomy -21. We report the anaesthetic management of a 22 year old male patient with genetically proven PWS (small stature, obesity with characteristic behaviour problem) who presented with chronic fissure in ano. Though the clinical course of the patient was uneventful under saddle block. In this case report we discuss our strategy for the prevention of perioperative complications for PWS patients.
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