Perioperative Management of Neurological Conditions

Abstract

Perioperative care of the patients with neurological diseases can be challenging. Most important consideration is the management and understanding of pathophysiology of these disorders and evaluation of new neurological changes that occur perioperatively. Perioperative generally refers to 3 phases of surgery: preoperative, intraoperative, and postoperative. We have tried to address few commonly encountered neurological conditions in clinical practice, such as delirium, stroke, epilepsy, myasthenia gravis, and Parkinson disease. In this article, we emphasize on early diagnosis and management strategies of neurological disorders in the perioperative period to minimize morbidity and mortality of patients.

Is seizure disorder a risk factor for complications following surgical treatment of hip dysplasia in the pediatric population?

“…Additionally, their compromised bone health along with potential falls experienced during seizures could put these patients at an increased risk of fracture following surgery. Because surgery and the use of anesthesia are also known to induce seizures in epileptic patients, it has been recommended that before surgery, these patients are kept on their AEDs [30]. With all of these factors considered, physicians and healthcare providers should be educated and take extra care when performing surgery for DDH on epileptic patients and ensure appropriate pre- and postoperative care.…”

Total knee replacement in a patient with myasthenia Gravis: A challenge that demands comprehensive perioperative care

“…Myasthenia Gravis is an autoimmune disease which involves peripheral cholinergic receptors of neuromuscular junctions [16] Dhallu MS, Baiomi A, Biyyam M and Chilimuri S found that younger women are more commonly affected than the middle-aged adults [17] . However, as per the study of Pakzad Z, Aziz T and Oger J, the incidence of myasthenia gravis is increasing in elderly population [7] .…”

Preoperative Evaluation of Patients with Neurological Disorders

“…Many of these medications can have sedative side effects or inhibit liver enzymes leading to oversedation. Additionally, proconvulsant medications should be limited intraoperatively and postoperatively including ketamine, methohexital, meperidine, and tramadol [9,[14][15][16][17] (Table 11.1). However, some controversy exists as to whether the use of ketamine is a relative or absolute contraindication, as the literature is not conclusive of this particular issue.…”

“…All antiparkinsons medications should be continued preoperatively. Most commonly, patients are treated with dopaminergic agents (carbidopalevodopa), dopamine agonists (pramipexole or ropinirole), MAO-B inhibitors (selegiline and rasagiline), and benztropine [6,14]. Flares of Parkinson's symptoms often occur with abrupt removal of medications, especially given the short half-life of levodopa [10].…”