Regional anesthesia in patients with pre-existing neurologic disease

McSwain, Julie R.; Doty, J. Wesley; Wilson, Sylvia H.

doi:10.1097/aco.0000000000000107

Cited by 26 publications

(24 citation statements)

References 61 publications

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“…(1-4) Si bien en algunos casos se ha reportado prolongación del tiempo de bloqueo. (4,5) Es desconocido el mecanismo por el que la alteración axonal en pacientes con ECMT se puede ver afectada por exposición directa a los anestésicos locales. (4) No obstante, se asume que tienen mayor susceptibilidad a los mismos debido a disminución y, en algunos casos, ausencia de mielina.…”

Section: Discussionunclassified

Anestesia intradural en la Enfermedad de Charcot-Marie-Tooth: A propósito de un caso

Caballero

Martínez

Sáiz

2020

Revista Electrónica AnestesiaR

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La neuropatía sensitivo-motora hereditaria, también conocida como Enfermedad de Charcot-Marie-Tooth, es una de las enfermedades hereditarias más frecuentes en nuestro país. Engloba un espectro de trastornos causados por mutaciones específicas en genes que codifican la mielina y que ocasionan defectos en su estructura, formación y mantenimiento. Existe escasa evidencia clínica disponible en relación al uso de anestesia regional en pacientes con esta enfermedad, lo que pone de manifiesto la necesidad de documentar los casos en los que se hayan empleado técnicas de anestesia locorregional con el fin de establecer estrategias de actuación.

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Section: Discussionunclassified

Anestesia intradural en la Enfermedad de Charcot-Marie-Tooth: A propósito de un caso

Caballero

Martínez

Sáiz

2020

Revista Electrónica AnestesiaR

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“…Few studies regarding safety in neuraxial and peripheral blocks in these patients can be found, the majority of them are obstetric case reports [11,12]. The risks of regional anesthesia in patients with neurofibromatosis rely basically on 2 major concerns: a theoretical spread of tumor cells and, most importantly, bleeding caused by manipulation of these tumors [4,11,12]. Therefore, those studies recommend a thorough neurological examination to discard possible previous alterations or intracranial and neuraxial tumors prior to regional anesthesia management [4,11,12] and after the surgery also a thorough neurological examination to ensure that the patient has returned to his preexisting neurologic status [3] and the documentation of these findings.…”

Section: Discussionmentioning

confidence: 99%

“…Neurofibromatosis affects every major anatomical system and brings for the anesthesiologist important issues related, most importantly, to potential airway difficulty, tumors affecting peripheral nerves, and neuraxial or intracranial tumors [3,4]. In the following case we discuss a patient with neurofibromatosis type 1 admitted for an open thoracotomy surgery for pulmonary tumor resection and the option for an alternate analgesic technique.…”

Section: Introductionmentioning

confidence: 99%

Continuous ESP Block Technique for an Open Thoracotomy in Neurofibromatosis Patient

Chimelli¹,

Andrade²,

Gonçalo³

et al. 2019

ASS

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Neurofibromatosis remains a challenge for the anesthesiologist as it brings issues especially regarding safety of anesthetic management such as airway management and neuraxial anesthesia. We report a case of a 60 year-old woman with controlled clinical comorbidities and neurofibromatosis, admitted for an open thoracotomy for excision of a growing pulmonary lesion, highly suspicious for malignancy. She had cutaneous tumors covering the majority of her skin. No neuroimage was available to exclude neuraxial or intracranial tumors, ensuring the safety for neuraxial anesthesia, therefore a combined technique was proposed with general anesthesia and a continuous erector spinae plane (ESP) block for anesthesia and analgesia. Surgery occurred successfully and there was no need to supplement or alter the initially planned anesthetic technique. Patient referred pain score ranging from 0-1 in rest and motion postoperative and required no complementary opioid for pain control. Infusion in the ESP catheter was maintained for 48h, after which it was removed and patient discharged without further complications or pain.

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“…In all cases where regional anesthesia is considered, the benefits must be weighed against potential complications; the greatest risk being a new or worsened neurologic deficit. With the advancement of regional techniques paired with ultrasound guidance, literature suggests that belonging to this patient population should not necessarily be a contraindication to regional anesthesia [2]. Due to the medicolegal concerns and historic avoidance of regional anesthesia in patients with neurologic disorders, there is a lack of discussion and studies in the United States on this topic.…”

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confidence: 99%

Use of Regional Anesthesia in Patients with Multiple Sclerosis

Gerhart

2020

GJAPM

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There are several clear benefits of regional anesthesia for surgical procedures. However, patients with pre-existing neurologic disorders create a unique challenge for the anesthesia provider considering the use of regional or neuraxial anesthesia. Specifically, patients with autoimmune mediated neurologic disorders that possess pre-existing neurologic deficits have been thought to be at a higher risk for neural compromise and therefore, are often excluded from the use of regional anesthesia [1]. In all cases where regional anesthesia is considered, the benefits must be weighed against potential complications; the greatest risk being a new or worsened neurologic deficit. With the advancement of regional techniques paired with ultrasound guidance, literature suggests that belonging to this patient population should not necessarily be a contraindication to regional anesthesia [2]. Due to the medicolegal concerns and historic avoidance of regional anesthesia in patients with neurologic disorders, there is a lack of discussion and studies in the United States on this topic. However, increasing support for the use of regional anesthesia for surgical procedures has produced a few studies within the United States and gained even more popularity internationally. This article will explain the pathophysiology of multiple sclerosis, evaluate current anesthetic practices and recent literature on regional anesthesia for patients with this disorder and provide recommendations for further studies and practice guidelines. After reading this article the reader will be able to properly identify and assess patients at an increased risk for neurologic compromise,

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Regional anesthesia in patients with pre-existing neurologic disease

Abstract: Regional anesthesia can be safely utilized in patients with pre-existing neurological disease and may have benefits over general anesthesia; however, a conservative approach is warranted. In addition, further publications regarding regional techniques in this population are needed.

Cited by 26 publications

References 61 publications

Anestesia intradural en la Enfermedad de Charcot-Marie-Tooth: A propósito de un caso

Anestesia intradural en la Enfermedad de Charcot-Marie-Tooth: A propósito de un caso

Continuous ESP Block Technique for an Open Thoracotomy in Neurofibromatosis Patient

Use of Regional Anesthesia in Patients with Multiple Sclerosis

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