[An anesthetic case of a patient with multiple sclerosis and supranuclear palsy]

A 60-year-old female with multiple sclerosis (MS) and supranuclear palsy (PSP) was scheduled for right eye iridotomy, left eye phaco emulcification aspiration and insertion of the intraocular lens. Her medical conditions included prolonged immobility, spastic contracture, and a history of convulsion. She was administered with L-dopa, tizanidine, bacrofen, and dantrorane. Anesthesia was induced with propofol 50 mg and fentanyl 25 microg intravenously, and inhalation of oxygen and 1% sevoflurane. Tracheal intubation was performed without neuromuscular blocking agents. Anesthesia was maintained with inhalation of oxygen-air (Fi(O2) 0.4) and 1-1.5% sevoflurane, combined with regional anesthesia. Supplemental fentanyl was administered as needed. The bispectral index (BIS) was monitored and kept between 40 and 60. The operation proceeded uneventfully. After discontinuation of anesthetic agents, she awoke immediately and the BIS index returned to the pre-induction level. Neither neurological disturbances nor unexpected event were observed postoperatively. In patients with MS, it is important to remember the possibility of drugs moving into the central nervou system easily due to the disturbance of the blood-brai barrier. Patients with PSP are usually medicated wit. various medicines which have possibility of interactin with anesthetics. Therefore, we used least anesthetic as possible. In this case, monitoring of BIS seemed to be useful to maintain the minimum sevoflurane concen trations needed.