The influence and impact of the local and general anesthetics on patients with neurological diseases

Abstract

the following characteristics: analgesia (relief from or prevention of pain), paralysis (extreme muscle relaxation), amnesia (loss of memory), and unconsciousness. Several surgical treatments can be employed for the patients with neurological disorders, such as multiple sclerosis, Guillain-Barré syndrome, Parkinson's disease, Alzheimer disease and spinal cord injury. It is possible that anesthesia related complications are induced in these neurologically complicated patients in the postoperative period. Respiratory dysfunction and autonomic nervous system dysfunction are most common in this population. Respiratory muscle weakness and bulbar palsy may cause aspiration pneumonia. Sometimes, postoperative ventilatory support is mandatory in these patients. Autonomic nervous system dysfunction may cause hypotension secondary to postural changes, blood loss, or positive airway pressure. Patients with motor neuron disease should be considered to be vulnerable to hyperkalemia in response to a depolarizing muscle relaxant. Although preoperative treatment guideline for most neurologic disorders has not been reported to lessen postoperative morbidity, knowledge of the clinical features and the interaction of common anesthetics with the drug therapy is important in planning intraoperative and postoperative management. Materials and methods: Performing general anesthesia in patients with preexisting neurologic or neuromuscular disease remains controversial.However, studies of significant size to confirm or support the safety of regional anesthesia in these patients continues to remain scarce. Specific guidelines regarding the use of anesthesia techniques in the setting of neurologic disease are difficult to define because of these limitations. Therefore, the goal of this chapter is to review several of the more common neurologic disorders that an anesthesiologist may encounter and outline what information currently exists to help guide the use of general anesthesia. Results: Every year, millions of people affected by disorders of the central nervous system (CNS) undergo various diagnostic, therapeutic and surgical procedures requiring administration of anesthetic agents. Anesthetics exert their anesthetic, amnesic and analgesic effects by acting on multiple neuronal membrane proteins in the CNS. While some of the causal anesthetic targets have been identified, a large number of anesthetic targets remain unknown. The consequent longterm effect of anesthetic agents on expression of these various molecular targets has been implicated in mediating potentially long-lasting adverse effects. Conclusion: The selection of appropriate anesthesia drugs and protocol is mandatory, especially in individuals with pre-existing central nervous system disorders, so as to maximize anesthesia efficiency, avoid occurrence of adverse events, and ensure patient safety. This review aims to summarize and consider the effects and potential risks of commonly used anesthetic agents in patients with compromised CNS function. We provide a comprehensive review of the established as well as theimplicated effects of anesthetic agents on the elderly as well as on the pathology and progression of common neurological conditions.