Anesthesia in neurologic and psychiatric diseases: is there a 'best anesthesia' for certain diseases?

PURPOSE OF REVIEW: Patients with diseases affecting the central nervous system present a wide range of clinical manifestations increasing the perioperative risk. The following review focused on recommendations for anaesthesiological management in patients with both neurologic and psychiatric diseases.

RECENT FINDINGS: The heterogeneity of disorders affecting the central nervous system and the variability of comorbidities make definition of standards for anaesthesiological management difficult. Anatomical malpositions, pulmonary and cardiac co-morbidities determine the perioperative risk. Patients require a careful preoperative assessment, including interdisciplinary communication between neurologists, psychiatrists or paediatric physicians. Adequate devices and equipment for airway management should be available before induction of general anesthesia. For premedication in patients with limited respiratory function, clonidine, given orally, is a good alternative. The use of short-acting hypnotic and analgesic drugs (e.g. propofol/remifentanil) can be safely administered for induction and maintenance of anesthesia. The use of volatile agents and succinylcholine is strictly avoided in patients with muscular dystrophy and myopathies. Peripheral and neuroaxial regional anesthesia is not contraindicated in patients with neuromuscular diseases unless there is a rapid deterioration of the neurological status.

SUMMARY: The 'best' anesthesia includes adequate preoperative evaluation of the individual risk, optimization of comorbidities before elective surgery, the use of short-acting anesthetic agents for induction and maintenance of general anesthesia, avoidance of volatile agents and succinylcholine in muscular dystrophy and myopathies.