Chronic inflammatory demyelinating polyradiculoneuropathy and anesthesia: a case series

Area of Science:

• Neurology
• Anesthesiology
• Immunology

Background:

• Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP) is an autoimmune disorder causing progressive muscle weakness.
• Patients with CIDP may present with bulbar and respiratory muscle involvement, posing anesthetic challenges.

Purpose of the Study:

• To evaluate perioperative outcomes in patients with active CIDP undergoing general anesthesia.
• To identify potential anesthetic risks, focusing on respiratory complications and reactions to muscle relaxants.

Main Methods:

• Retrospective observational study of 17 patients with active CIDP who received general anesthesia between 2010 and 2015.
• Review of medical records for perioperative complications, including respiratory issues and neuromuscular blockade effects.

Main Results:

• 16 of 17 patients had muscle weakness; neuromuscular drugs were used in most cases.
• Two patients required postoperative mechanical ventilation; one experienced aspiration and required ventilation.
• Three patients had worsening CIDP symptoms, including one fatality due to malnutrition after surgery.

Conclusions:

• While patients tolerated neuromuscular drugs, theoretical concerns remain for those with demyelinating neuropathies.
• Anesthetic management for CIDP patients requires careful consideration of frailty, bulbar dysfunction, and immunosuppressive therapy.
• Further research is essential to establish safe anesthetic protocols for CIDP patients.