Preoperative Evaluation of Patients with Neurological Disease
29 December 2008 (online)
A thorough evaluation of patients with neurological diseases undergoing surgery can reduce perioperative morbidity and mortality, especially stroke. Various neurological disorders and neurosurgical procedures may influence the nature and extent of preoperative evaluation, selection and conduct of anesthesia, and perioperative management and care. Although anesthesiologists primarily perform a preoperative evaluation of neurological patients, neurologists can contribute further valuable information about the neurological condition and perioperative management of various neurological diseases to obtain the best possible outcome. This article outlines the basic elements of preoperative evaluation and highlights specific considerations for neurological patients undergoing surgery.
Preoperative evaluation - neurological disease - neurosurgery
- 1 Roizen M F.
Preoperative evaluation. In: Miller RD Anesthesia. Vol. 1. New York, NY; Churchill. Livingstone 2000: 927-997
- 2 Malone D L, Genuit T, Tracy J K et al.. Surgical site infections: reanalysis of risk factors. J Surg Res. 2002; 103(1) 89-95
- 3 Patel K L. Impact of tight glucose control on postoperative infection rates and wound healing in cardiac surgery patients. J Wound Ostomy Continence Nurs. 2008; 35(4) 397-404
- 4 Cohn S L, Goldman L. Preoperative risk evaluation and perioperative management of patients with coronary artery disease. Med Clin North Am. 2003; 87(1) 111-136
- 5 Chiu J W, White P F.
Nonopioid intravenous anesthesia. In: Barash PG, Cullen BF, Stoelting RK Clinical Anesthesia. 4th ed. Philadelphia, PA; Lippincott Williams and Wilkins 2001: 327-343
- 6 Landercasper J, Merz B J, Cogbill T H et al.. Perioperative stroke risk in 173 consecutive patients with a past history of stroke. Arch Surg. 1990; 125 986-989
- 7 Colson P, Ryckwaert F, Coriat P. Renin angiotensin system antagonists and anesthesia. Anesth Analg. 1999; 89(5) 1143-1155
- 8 Bertrand M, Godet G, Meersschaert K et al.. Should the angiotensin II antagonists be discontinued before surgery?. Anesth Analg. 2001; 92(1) 26-30
- 9 Tamai D, Awad A A, Chaudhry H J et al.. Optimizing the medical management of diabetic patients undergoing surgery. Conn Med. 2006; 70(10) 621-630
- 10 Mercado D L, Petty B G. Perioperative medication management. Med Clin North Am. 2003; 87 41-57
- 11 Armstrong M J, Schneck M J, Biller J. Discontinuation of perioperative antiplatelet and anticoagulant therapy in stroke patients. Neurol Clin. 2006; 24(4) 607-630
- 12 Traber K B.
Preoperative evaluation. In: Longnecker DE, Murphy FL Introduction to Anesthesia. 9th ed. Philadelphia, PA; WB Saunders Co 1997: 11-19
- 13 Brussel T, Chernow B. Perioperative management of endocrine problems: thyroid, adrenal cortex, pituitary. J Am Soc Anesthesiol. 1990; 18 33-48
- 14 Sarko J. Antidepressants, old and new: a review of their adverse effects and toxicity in overdose. Emerg Med Clin North Am. 2000; 18 637-654
- 15 Goldberg J F. New drugs in psychiatry. Emerg Med Clin North Am. 2000; 18(2) 211-231
- 16 Fleisher L A. Preoperative evaluation In: Barash PG, Cullen BF, Stoelting RK Clinical Anesthesia. 4th ed. Philadelphia, PA; Lippincott Williams and Wilkins 2001: 473-489
- 17 Bradley P G, Menon D K. Preoperative evaluation of neurosurgical patients. Anaesth Intensive Care Med. 2004; 5(10) 336-339
- 18 Practice Advisory for Preanesthesia Evaluation . A report by the American Society of Anesthesiologists Task Force on preanesthesia evaluation. Anesthesiology. 2002; 96 485-496
- 19 Dempsey D T, Mullen J L, Buzby G P. The link between nutritional status and clinical outcome: can nutritional intervention modify it?. Am J Clin Nutr. 1988; 47(S2) 352-356
- 20 Qaseem A, Snow V, Fitterman N et al.. Risk assessment for and strategies to reduce perioperative pulmonary complications for patients undergoing noncardiothoracic surgery: a guideline from the American College of Physicians. Ann Intern Med. 2006; 144(8) 575-580
- 21 Gibbs J, Cull W, Henderson W et al.. Preoperative serum albumin level as a predictor of operative mortality and morbidity: results from the National VA Surgical Risk Study. Arch Surg. 1999; 134(1) 36-42
- 22 Brown Jr R D, Evans B A, Wiebers D O et al.. Transient ischemic attack and minor ischemic stroke: an algorithm for evaluation and treatment. Mayo Clinic Division of Cerebrovascular Diseases. Mayo Clin Proc. 1994; 69(11) 1027-1039
- 23 Joyce III T H. Prophylaxis for pulmonary acid aspiration. Am J Med. 1987; 83(6A) 46-52
- 24 Fleisher L A, Beckman J A, Brown K A et al.. ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) developed in collaboration with the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, and Society for Vascular Surgery. J Am Coll Cardiol. 2007; 50(17) e159-e241
- 25 Poldermans D, Boersma E, Bax J J et al.. Bisoprolol reduces cardiac death and myocardial infarction in high-risk patients as long as 2 years after successful major vascular surgery. Eur Heart J. 2001; 22(15) 1353-1358
- 26 Mangano D T, Layug E L, Wallace A et al.. Effect of atenolol on mortality and cardiovascular morbidity after noncardiac surgery. Multicenter Study of Perioperative Ischemia Research Group. N Engl J Med. 1996; 335(23) 1713-1720
- 27 Hamilton M G, Hull R D, Pineo G F. Venous thromboembolism in neurosurgery and neurology: a review. Neurosurgery. 1994; 34 280-296
- 28 Lefevre F, Woolger J M. Surgery in the patient with neurologic disease. Med Clin North Am. 2003; 87(1) 257-271
- 29 Meguid M M, Campos A C, Hammond W G. Nutritional support in surgical practice: Part II. Am J Surg. 1990; 159(4) 427-443
- 30 Warner M A, Offord K P, Warner M E, Lennon R L, Conover M A, Jansson-Schumacher U. Role of preoperative cessation of smoking and other factors in postoperative pulmonary complications: a blinded prospective study of coronary artery bypass patients. Mayo Clin Proc. 1989; 64(6) 609-616
- 31 Larach M G, Rosenberg H, Gronert G A. Hyperkalemic cardiac arrest during anesthesia in infants and children with occult myopathies. Clin Pediatr (Phila). 1997; 36(1) 9-16
- 32 Kunst G, Graf B M, Schreiner R et al.. Differential effects of sevoflurane, isoflurane, and halothane on Ca2+ release from the sarcoplasmic reticulum of skeletal muscle. Anesthesiology. 1999; 91(1) 179-186
- 33 Birnkrant D J, Panitch H B, Benditt J O et al.. American College of Chest Physicians consensus statement on the respiratory and related management of patients with Duchenne muscular dystrophy undergoing anesthesia or sedation. Chest. 2007; 132(6) 1977-1986
- 34 Baraka A. Anesthesia and myasthenia gravis. Can J Anaesth. 1992; 39 476-486
- 35 Seifert H S, Smith D S.
Neuroanesthesia and neurologic disease. In: Longnecker DE, Murphy FL Introduction to Anesthesia. 9th ed. Philadelphia, PA; WB Saunders Co 1997: 400-414
- 36 Dierdorf S F.
Anesthesia for patients with rare and coexisting disease. In: Barash PG, Cullen BF, Stoelting RK Clinical Anesthesia. 4th ed. Philadelphia, PA; Lippincott Williams and Wilkins; 2001: 491-520
- 37 Turnbull J M, Buck C. The value of preoperative screening investigations in otherwise healthy individuals. Arch Intern Med. 1987; 147(6) 1101-1105
- 38 Limburg M, Wijdicks E F, Li H. Ischemic stroke after surgical procedures: clinical features, neuroimaging, and risk factors. Neurology. 1998; 50(4) 895-901
- 39 Restrepo L, Wityk R J, Grega M A et al.. Diffusion- and perfusion-weighted magnetic resonance imaging of the brain before and after coronary artery bypass grafting surgery. Stroke. 2002; 33(12) 2909-2915
- 40 Kluger J, White C M. Amiodarone prevents symptomatic atrial fibrillation and reduces the risk of cerebrovascular accidents and ventricular tachycardia after open heart surgery: results of the Atrial Fibrillation Suppression Trial (AFIST). Card Electrophysiol Rev. 2003; 7(2) 165-167
- 41 Sibon I, Orgogozo J M. Antiplatelet drug discontinuation is a risk factor for ischemic stroke. Neurology. 2004; 62(7) 1187-1189
- 42 Fox K A, Mehta S R, Peters R et al.. Benefits and risks of the combination of clopidogrel and aspirin in patients undergoing surgical revascularization for non-ST-elevation acute coronary syndrome: the Clopidogrel in Unstable angina to prevent Recurrent ischemic Events (CURE) Trial. Circulation. 2004; 110(10) 1202-1208 , Epub 2004 Aug 16e
- 43 Siemkowicz E. Multiple sclerosis and surgery. Anaesthesia. 1976; 31(9) 1211-1216
- 44 Kyttä J, Rosenberg P H. Anaesthesia for patients with multiple sclerosis. Ann Chir Gynaecol. 1984; 73(5) 299-303
- 45 Annegers J F. Epidemiology and genetics of epilepsy. Neurol Clin. 1994; 12 15-29
- 46 Bogaard J M, Hovestadt A, Meerwaldt J et al.. Maximal expiratory and inspiratory flow-volume curves in Parkinson's disease. Am Rev Respir Dis. 1989; 139(3) 610-614
Magdy H Selim, M.D. , Ph.D.
Department of Neurology, Division of Cerebrovascular Diseases, Beth Israel Deaconess Medical Center
330 Brookline Avenue – Palmer 127, Boston, MA 02215