Multiple sclerosis an chronic demyelinating disease and anesthesia management

Multiple sclerosis (MS) is an immune-mediated disease of the central nervous system (CNS) and the most common chronic demyelinating disease affecting approximately 2.8 million people worldwide. Its high prevalence worldwide makes it probable for an anesthesia professional to take care of a patient diagnosed with MS at some point during their career. MS is an immune-mediated disease characterized by inflammation, demyelination, and axonal damage in the central nervous system. The course of MS is characterized by exacerbations and remissions at unpredictable intervals over a period of several years. Progression of disability due to MS is highly variable among patients. General, epidural, and spinal anesthesia are generally deemed safe when used in patients with the disease. General anesthesia is the most common anesthetic technique used. There is more controversy surrounding spinal anesthesia, but it seems spinal anesthesia can be administered safely without any additional increased risk of disease relapse. The purpose of the preoperative assessment is to ensure the patient undergoes a safe and adequate anaesthetic experience by selecting the most suitable type of anaesthesia. This assessment must include the full documentation of the neurological deficits detailed by the neurologist in charge of the patient. The use of an established score such as the “Expanded Disability Status Scale” score or “EDSS” score should also be used in order to evaluate the degree of disability. Besides neurological data, the preoperative assessment conducted by the anaesthesiologist should also document any respiratory, cardiac, renal, hepatic, autonomic or any other medical comorbidities. There is a lack of published guidelines on the management of patients with multiple sclerosis (MS) undergoing procedures that require anaesthesia. The anaesthetic management covers preoperative assessment, choice of anaesthetic techniques and agents, side-effects of drugs used during anaesthesia and their potential impact on the disease evolution and drug interactions. The choice of the anaesthetic technique used should be made after careful assessment of the risks and benefits for each specific patient and his preference must also be considered. The association of general anaesthesia and epidural with low concentrations of local anaesthetic are considered safe. Post-operative MS relapses are not affected by the choice of the anaesthetic technique, and that all techniques, including general anaesthesia, may be safely used.