[Anesthetic management for a patient with multiple sclerosis]

Area of Science:

• Anesthesiology
• Neurology

Background:

• Multiple sclerosis (MS) presents unique challenges for anesthesia due to potential autonomic dysfunction and increased sensitivity to anesthetic agents.
• Patients with MS may experience altered responses to neuromuscular blocking agents, necessitating careful anesthetic management.

Observation:

• A 49-year-old female patient with a 13-year history of multiple sclerosis (MS) required emergency laparotomy for panperitonitis.
• Her MS symptoms included significant visual, ambulatory, and sensory deficits below the T7 dermatome.
• Anesthesia was induced with propofol and fentanyl, maintained with nitrous oxide and sevoflurane, and supplemented with fentanyl.

Findings:

• Muscle relaxants were avoided during intubation and their use minimized throughout surgery, guided by train-of-four monitoring.
• Hemodynamic stability was maintained without the need for cardiovascular agents during the entire procedure.
• The patient experienced an uneventful emergence from anesthesia with no observed worsening of her pre-existing neurological deficits.

Implications:

• This case demonstrates the feasibility of a muscle-relaxant-sparing anesthetic technique in patients with multiple sclerosis undergoing major abdominal surgery.
• Careful anesthetic planning and monitoring can ensure patient safety and prevent postoperative neurological deterioration in MS patients.
• The findings support the consideration of reduced neuromuscular blockade in specific neurological conditions to optimize recovery.