Perioperative care of the surgical patient with neurologic disease
- Geno J Merli, MD, FACP, FHM
Geno J Merli, MD, FACP, FHM
- Professor of Medicine
- Jefferson Medical College
- Rodney D Bell, MD
Rodney D Bell, MD
- Professor of Neurology
- Jefferson Medical College
- Section Editor
- Michael J Aminoff, MD, DSc
Michael J Aminoff, MD, DSc
- Editor-in-Chief — Neurology
- Section Editor — Medical Neurology
- Professor of Neurology
- University of California, San Francisco School of Medicine
- Deputy Editors
- Janet L Wilterdink, MD
Janet L Wilterdink, MD
- Senior Deputy Editor — UpToDate
- Deputy Editor — Neurology
- Associate Professor
- Brown University School of Medicine
- Marianna Crowley, MD
Marianna Crowley, MD
- Deputy Editor — Anesthesiology
- Assistant Professor of Anesthesiology
- Harvard Medical School
Perioperative care of the patient with neurologic disease is a challenge for the medical consultant. The most important considerations are the management of medications used to treat neurologic disorders, an understanding of the pathophysiologic mechanism of these disorders, and evaluation of new neurologic changes that occur perioperatively. The more commonly encountered neurologic disorders and their perioperative management are reviewed here.
At least one million people in the United States have recurrent seizures or epilepsy . Most patients with epilepsy are managed with antiepileptic drugs (AEDs). (See "Overview of the management of epilepsy in adults".)
People with epilepsy appear to be at significant risk of postoperative complications, some of which are attributed to epilepsy and some to comorbidities associated with epilepsy. In one retrospective database study, 13,103 patients with epilepsy had a higher rate of postoperative complications compared to those without epilepsy (OR = 2) . Stroke was identified as the most significant postoperative complication in patients with epilepsy.
Causes of seizures in perioperative patients — Seizures can occur during the perioperative period due to a number of causes:
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- SEIZURE DISORDERS
- Causes of seizures in perioperative patients
- - Anesthesia
- - Metabolic derangements
- - Drug and alcohol withdrawal
- - Intracranial surgery
- Medication management
- - Phenytoin
- - Others
- PARKINSON DISEASE
- Swallowing abnormalities
- Pulmonary function
- Perioperative medication management
- MYASTHENIA GRAVIS
- Medication management
- Drugs that may exacerbate myasthenia
- MALIGNANT HYPERTHERMIA
- CEREBROVASCULAR DISEASE
- Patients with a history of stroke
- Perioperative stroke
- - Asymptomatic carotid bruit
- - Vertebrobasilar disease
- Relationship to cardiovascular disease
- CHANGE IN MENTAL STATUS
- SUMMARY AND RECOMMENDATIONS