Leprosy and the anesthesiologist

Abstract

Purpose: To discuss particular aspects of leprosy (complications treatment, special population) that have implications for anesthetic management in leprous patients scheduled for surgery.Source: MEDLINE and manual searches of relevant literature. Multiple MEDLINE searches (from 1966 onwards) were done, using LEPROSY as a common Medical Subject Heading (MeSH). Other headings used were: anesthesia, surgery, cardiovascular system, respiratory system, eye, skin, nervous system, genitalia, pathology, psychology and pregnancy. A large number of references were retrieved, but only 18 of them were relevant to our topic. Others were obtained by manual search and cross referencing.Principal findings: Leprosy, especially lepromatous leprosy, is a systemic disease, affecting many organs and systems of the body, e.g., cardiovascular (cardiac dysautonomia), respiratory (impaired cough response, nasal obstruction), hepatobiliary (hepatitis), renal (nephritis), ocular (anesthesia), hematological (reduced red, white and platelet count) and osseous systems (bone resorption). Conclusion:Investigation of the systems likely to be affected by leprosy (e.g., complete hemogram, liver, lung and kidney function tests, Valsalva response, assessment of ocular anesthesia) should form part of a preanesthetic check up in patients with leprosy.Objectif : Discuter des aspects particuliers de la lèpre (traitement des complications, population spéciale) ayant des implications anesthésiques chez les patients atteints de cette maladie qui doivent subir une intervention chirurgicale.Source : MEDLINE et des recherches manuelles dans la documentation appropriée. Des recherches multiples ont été faites dans MEDLINE (à partir de 1966) en utilisant le terme LÈPRE comme principal sujet médical commun. Les autres ont été : anesthésie, chirurgie, système cardiovasculaire, système respiratoire, yeux, peau, système nerveux, organes génitaux, pathologie, psychologie et grossesse. Du grand nombre d'articles retenus, seulement 18 d'entre eux concernaient notre recherche. On a obtenu d'autres articles par recherche manuelle et références croisées.Constatations principales : La lèpre, en particulier la lèpre lépromateuse, est une maladie généralisée qui affecte de nombreux organes et systèmes de l'organisme, comme les systèmes cardiovasculaire (dysautonomie cardiaque), respiratoire (altération du réflexe de toux, obstruction nasale), hépato-biliaire (hépatite), rénal (néphrite), oculaire (anesthésie), hématologique (numération érythrocytaire, leucocytaire et plaquettaire réduite) et osseux (résorption osseuse).Conclusion : Une exploration des systèmes pouvant être affectés par la lèpre (hémogramme complet, tests des fonctions hépatique, pulmonaire et rénale, épreuve de Valsalva, évaluation de l'anesthésie oculaire) devrait faire partie de l'examen préanesthésique chez les patients atteints.

Leprosy, Ancient Disease and Modern Anaesthetic Considerations

“…Leprosy is a systemic disease that affects different systems and organs in infected patients. The more advanced the disease (lepromatous leprosy), the more damaged the internal organs and systems would be ( 7 ). Since there are few clinical articles regarding the anaesthetic aspects of the disease, most of the considerations about leprosy come from case reports ( 7 ).…”

“…Cardiovascular involvement may represent itself during leprosy as congestive heart failure, bundle branch blocks, dysrhythmia and increased QTc interval ( 7 , 8 ). Together with cardiovascular involvement, the affected respiratory system is a challenge for anaesthesiologists as well; the largest numbers of bacilli are colonised in the nasal mucosa, which may endanger the anaesthesiology team.…”

“…Together with cardiovascular involvement, the affected respiratory system is a challenge for anaesthesiologists as well; the largest numbers of bacilli are colonised in the nasal mucosa, which may endanger the anaesthesiology team. The affected patient may show decreased cough response ( 7 ), which potentially increases the risk of aspiration in the perioperative period. Skeletal deformities could be seen as well ( 7 ); if these deformities happen in the head and neck, anaesthesiologists should be prepared for a potential difficult airway.…”

“…The affected patient may show decreased cough response ( 7 ), which potentially increases the risk of aspiration in the perioperative period. Skeletal deformities could be seen as well ( 7 ); if these deformities happen in the head and neck, anaesthesiologists should be prepared for a potential difficult airway. Autonomic neuropathy could be another burden to anaesthesiologists.…”

A very common case become rare: Anesthetic considerations of lepromatous leprosy

“…Patient may be posted for surgery either related to the complication of leprosy like cataract, joint deformities, planter ulceration or elective and emergency surgical procedure related to systemic diseases. [9]…”