Anesthetic considerations in a patient with multiple system atrophy-cerebellar for lower limb surgery

Agarwal, Sandhya; Aggarwal, R.

doi:10.4103/sja.sja_57_17

Cited by 3 publications

(6 citation statements)

References 5 publications

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“…These patients are also at risk for delirium and/or agitation making cooperation with regional, neuraxial, and especially local anesthesia potentially problematic. While there are published reports of surgical procedures under single-shot spinal anesthesia [ 7 ], the general consensus among practitioners seems to be that if possible, low-dose spinal or epidural anesthesia should be used and titrated carefully to minimize hemodynamic compromise [ 6 ]. Should general anesthesia be necessary, an arterial line should be placed [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…Multiple system atrophy (MSA) is a progressive neurodegenerative disorder characterized mainly by autonomic failure (including autonomic instability) and motor impairment. Anesthesia of any kind in affected patients carries significant risk [ 6 ]. Inguinal hernia repair (IHR) is one of the most commonly performed surgical procedures and is routinely performed under general, spinal, or even local anesthesia with sedation.…”

Section: Introductionmentioning

confidence: 99%

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Quadratus Lumborum Block as Sole, Homeostatic-Preserving Anesthetic for a Patient with Multiple System Atrophy Undergoing Open Inguinal Hernia Repair: A Case Report

Colla

Schroeder

2018

Case Reports in Anesthesiology

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Quadratus Lumborum (QL) block has been successfully used for different abdominal procedures in the past. Multiple system atrophy (MSA) is a progressive neurodegenerative disorder characterized mainly by autonomic instability, motor impairment, and cognitive dysfunction. We report a case of a patient with MSA with a history of multiple episodes of unplanned admissions following outpatient minor surgical procedures under general anesthesia scheduled to undergo open inguinal hernia repair. In our patient, QL block was successfully used for surgical anesthesia and it resulted in hemodynamic stability and an opioid-free perioperative course.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Quadratus Lumborum Block as Sole, Homeostatic-Preserving Anesthetic for a Patient with Multiple System Atrophy Undergoing Open Inguinal Hernia Repair: A Case Report

Colla

Schroeder

2018

Case Reports in Anesthesiology

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“…Autonomic neuropathy involves both sympathetic and parasympathetic nervous system. Subarachnoid blockade may cause profound hypotension [5]. Therefore, general anesthesia is usually preferred for any surgical procedure.…”

Section: Discussionmentioning

confidence: 99%

Anesthetic Management of a Short Urological Procedure in a Patient With Multisystem Atrophy - Cerebellar Type: A Case Report

NAGELLA,

AKRAM,

et al. 2023

Asian J Pharm Clin Res

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Multisystem atrophy cerebellar type (MSA-C) is a rare, fatal, and progressive neurological disorder characterized by features of atypical parkinsonism and autonomic dysfunction. This condition poses numerous challenges in the perioperative period to the anesthesiologist for the safe conduct of anesthesia. Here, we report a case of 65-year-old male patient with the diagnosis of MSA-C who was posted for a short urological procedure. General anesthesia is usually preferred for MSA-C patients due to the autonomic dysfunction. However, after considering the risks of general anesthesia in MSA-C, we administered a low-dose spinal anesthetic. The patient was hemodynamically throughout the surgery and the post-operative period was uneventful.

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“…In line with similar literature [ 14 , 16 , 17 ], we recommend for careful maintenance of euvolaemia by ensuring adequate preoperative hydration during the fasting period and continuous haemodynamic and cardiac monitoring perioperatively (e.g., arterial and central venous catheterisation and the EV1000 platform as was used with our patient). Atropine-resistant bradycardia is a documented phenomenon secondary to dysautonomia, thus alternatives such as isoprenaline and temporary pacing should be considered in severe cases [ 18 ]. We also considered that a dopamine beta-hydroxylase deficiency seen in MSA-C might contribute to poor sympathetic tone [ 18 ], and we therefore used noradrenaline as the preferred vasopressor.…”

Section: Case Reportmentioning

confidence: 99%

“…Atropine-resistant bradycardia is a documented phenomenon secondary to dysautonomia, thus alternatives such as isoprenaline and temporary pacing should be considered in severe cases [ 18 ]. We also considered that a dopamine beta-hydroxylase deficiency seen in MSA-C might contribute to poor sympathetic tone [ 18 ], and we therefore used noradrenaline as the preferred vasopressor. Importantly, medications for orthostatic hypotension (i.e., fludrocortisone) can increase the risk of supine hypertension perioperatively [ 17 ].…”

Section: Case Reportmentioning

confidence: 99%

Anaesthesia techniques and advanced monitoring in CANVAS patients - Implications for postoperative morbidity and patient recovery: A case report

Weinberg

Hungenahally

Meyerov

et al. 2021

International Journal of Surgery Case Reports

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Introduction Cerebellar ataxia, neuropathy and vestibular areflexia syndrome (CANVAS) is a rare multisystem neurodegenerative disorder. We describe our perioperative evaluation and care of a patient with CANVAS undergoing a pancreaticoduodenectomy for an ampullary adenocarcinoma, with a focus on perioperative risk stratification and optimisation, intraoperative advanced haemodynamic monitoring and the postoperative care. Case presentation A 69-year-old female with CANVAS presented with asymptomatic obstructive jaundice, icterus and abdominal pain. She had limited mobility and deconditioning due to severe generalised neuropathy. Computed tomography confirmed a resectable periampullary tumour. Her Duke Activity Status Index was 8.25 points and Edmonton Frailty Scale score was 11, confirming moderate frailty. However, the Charlson Comorbidity Index was five, indicative of a 21% estimated 10-year survival. Further risk stratification including respiratory function testing, echocardiography and cardiopulmonary exercise testing was conducted. The patient proceeded with surgery after multidisciplinary discussions with her treating medical teams. Discussion CANVAS is a rare and challenging condition requiring careful perioperative planning and management. There is no effective treatment for CANVAS. The management approach focuses on mitigating symptoms and improving quality of life. Given that no specific guidelines for managing these patients in the perioperative period have been provided, this report highlights several critical medical issues and implications that should be considered for the successful management of these patients. We demonstrate the role of specific anaesthesia techniques and advanced haemodynamic monitoring in both preventing postoperative morbidity and optimising patient recovery. Conclusion CANVAS is a rare and challenging condition in anaesthesia requiring careful perioperative planning and management.

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Anesthetic considerations in a patient with multiple system atrophy-cerebellar for lower limb surgery

Cited by 3 publications

References 5 publications

Quadratus Lumborum Block as Sole, Homeostatic-Preserving Anesthetic for a Patient with Multiple System Atrophy Undergoing Open Inguinal Hernia Repair: A Case Report

Quadratus Lumborum Block as Sole, Homeostatic-Preserving Anesthetic for a Patient with Multiple System Atrophy Undergoing Open Inguinal Hernia Repair: A Case Report

Anesthetic Management of a Short Urological Procedure in a Patient With Multisystem Atrophy - Cerebellar Type: A Case Report

Anaesthesia techniques and advanced monitoring in CANVAS patients - Implications for postoperative morbidity and patient recovery: A case report

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