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General Considerations in Multiple Sclerosis
- Definitive evidence on the risks or safety of anaesthesia in patients with multiple sclerosis is limited by the disease’s unpredictable natural course.
- Factors other than anaesthesia in the perioperative period (stress, infection) may potentially contribute to exacerbations.
- Late pregnancy may be associated with a temporary improvement in MS symptoms, as well as relapse during the postpartum period
Clinically silent demyelination may be potentially unmasked by relative minor factors.
- Established risk factors should be avoided, and potential risks minimised in tailoring an anaesthetic plan to a specific patient and procedure.
- Increased body temperature exacerbates disease and must be carefully avoided
- Consider caution in use of anticholinergics which may inadvertently increase body temperature
- Denervation of motor end plates may potentially cause hyperkalaemia in response to depolarising neuromuscular blockade
- Both increased sensitivity and resistance have been described in relation to non-depolarising neuromuscular blockade
- Consider potential for autonomic dysfunction in patients with advanced disease and use appropriate monitoring
- Definitive evidence on the safety of neuraxial anaesthesia is lacking
- spinal anaesthesia exposes the spinal cord to higher concentrations of potentially toxic local anaesthetic than epidurals.
- Consequently, epidurals may be safer than spinals
- While considered a disease of the central nervous system, peripheral nerve demyelination occurs with increased frequency in MS, and risks exacerbation by peripheral nerve blocks.
Reducing local anaesthetic concentration and total dose to the lowest effective levels may be prudent for both peripheral and neuraxial blockade.