Multiple sclerosis

 

Issues:

Airway

·      ±Bulbar palsy

·      GORD

->Risk of aspiration

Respiratory

·      ±Restrictive impairment

·      ↔TLC, VC

·      ↓FRC, MIP, MEP

->Risk of post-op T2RF. Consider HDU.

Cardiovascular

·      ±Autonomic instability -> intolerance of hypovolaemia

·      ±Adrenocortical suppression

->Risk of severe hypotension. Infuse pressor.

Neuromuscular

·      Upregulated extrajunctional receptors

->Suxamethonium dangerous

->Sensitive to non-depolarising drugs -> risk of inadequate reversal

Causes of relapse

·      Hyperthermia

·      Infection

·      Stress

->Aim for mild hypothermia

Neuraxial block

·      Local anaesthetics may be neurotoxic in MS.

·      Some evidence of increased relapse. Unclear

·      Prefer lower concentration

·      Prefer epidural to spinal

->Avoid neuraxial

->Regional is ok – not CNS!

->Document neurological exam before and afterward

Medication side effects

·      Glucocorticoids -> usual list

·      IFN -> ∆LFT, ↓WCC, depression, flu-like symptoms

·      Baclofen -> weakness, sensitivity to NMBD

·      Biologics -> immune deficiency

 

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