Going Under the Knife With MS
[ad_1]
I lost a hip a number of years ago. Not that I “lost” it, like I was careless or something. The multiple, five-day infusions of corticosteroids that were required to keep my multiple sclerosis (MS) in check (sort of) in the first few years after diagnosis did their damage, and the hip ultimately needed to be replaced.
There were many aftercare directions that I had to follow postoperatively. Most had to do with rehabilitation of the joint and the muscles disrupted during the replacement.
One, however, requires lifelong awareness: Due to the nature of the implantation, etc., I will always have to take prophylactic antibiotics if ever I undergo dental work. Something about bacteria entering the bloodstream and not wanting an infection in the bone around the prosthetic hip.
Sounds like something that should be avoided!
How Does Anesthesia During Surgery Affect MS?
One thing that didn’t come up in any substantive conversations before that surgery or any of the times I’ve gone under the knife since (and as I thought about it, there weren’t an insignificant number of times) was how my multiple sclerosis might affect or be affected by surgery.
It seems that may be changing.
A review of relevant studies in a recent issue of Multiple Sclerosis and Related Disorders offered up recommendations for anesthetists and neurologists for the management of patients with MS requiring anesthesia.
The article lays out several aspects of anesthesia and multiple sclerosis that should be considered. From preoperative assessment — including respiratory assessment, autonomic dysfunction (think bladder and bowel issues), and MS-related cardiovascular involvement — to MS medication interactions with surgical drugs to the techniques and medications used in anesthesia and more, there is much for our specialists to discuss before we ever enter the operating theater.
The researchers even discuss pregnancy and delivery — and the types of anesthesia that may be used during delivery — in relation to MS in this paper.
Postoperative care was highlighted with specific interest paid to infection and relapse triggers of surgical procedures.
If you’ve the time and inclination, it really is an impressively assembled paper with scores of citations and references that were of great interest to me.
Recommendations Gleaned From Research
In summarizing their key points of the study, researchers made the following recommendations, aimed at healthcare providers involved in the care of people with MS. Some of the terms used are likely to be unfamiliar to the layperson, so if surgery or delivering a baby is in your future, talk to your doctor(s) about which of these recommendations apply to you.
- A preoperative evaluation should comprise a detailed patient’s neurological status.
- The risk of relapse in the postoperative period should be explained to the patient during the preoperative assessment.
- Preoperative contact between the patient’s neurologist and the anesthetist is recommended.
- Regularly administered disease-modifying therapies (DMTs) should not be stopped in the preoperative period.
- The use of depolarizing neuromuscular blocking agents should be avoided.
- Nondepolarizing agents should be used under close monitoring.
- General anesthesia is thought to be safe.
- There are no absolute contraindications for regional or neuraxial anesthesia in people with MS.
- There is no consensus on optimum technique to use in pregnant women with MS.
- Both subarachnoid and epidural blocks are considered safe in pregnant women with MS.
- There is no association between the post-pregnancy relapse rate and anesthesia procedures or drugs used.
- Close perioperative monitoring of hemodynamic, respiratory function, neuromuscular, and temperature is mandatory.
- Specific attention is required for postoperative complications, such as infection, delayed wound healing, and venous thrombosis.
With Adequate Precautions, Surgery Can Be Safe
Finally, in concluding, they stated, “Multiple sclerosis is a demyelinating disease of the CNS that has implications for anesthesia. Triggers of MS relapses include infections and fever of other causes, while surgical procedures and emotional stress are still controversial. The interdisciplinary management of pwMS [people with MS] should optimize medical follow-up and allow him/her to be fully informed. With thorough preoperative evaluation, knowledge about the disease, the medications used to treat MS, and the various complications that pwMS may encounter, these patients can be managed safely.”
Something to think about if we’re considering surgery. There always seems to be something else to consider when we have MS. At least we now know what we need to know.
Wishing you and your family the best of health.
Cheers,
Trevis
My new book, Living Well with Multiple Sclerosis, is available for preorder on Amazon. Follow me on the Life With MS Facebook page, and read more on Life With Multiple Sclerosis.
[ad_2]
