Anesthesia management in patients with neurological diseases: an updated systematic review

Abstract

Prior literature discouraged anesthesiologists from administering regional anesthesia on patients with pre-existing neurologic disorders. Anesthesiologists are occasionally faced with adopting a regional anesthetic method in patients with pre-existing neurological diseases. There is uncertainty about whether secondary variables such as patient characteristics and anesthetic and surgical risk factors might influence the post-operative neurological outcome. To review the current literature on the anesthetic management of patients with neurological diseases. Studies related to our subject were explored using PubMed and Google scholar databases. The keywords included were "Anesthesia, anesthetic management, neurological disease, regional anesthesia," and were used in various combinations. The inclusion criteria were original studies that reported Anesthesia management in patients with neurological disease and full text- articles. A total of 100 articles were obtained, only 8 articles were eligible for the inclusion criteria were published between 2004 and 2021. The detailed studies were conducted on 156 participants, two of them were case series, and six were case reports. Patients with central nervous system (CNS) problems such as multiple sclerosis (MS), amyotrophic lateral sclerosis, Tuberous sclerosis, and brain tumors were included in our study. General anesthesia has been associated with worsening MS. A bupivacaine-based scalp nerve block and Dexmedetomidine were used as the primary hypnotic-sedative medicine to perform awake craniotomies on 10 patients, allowing safe tumor removal. The study shows that the risks associated with neuraxial anesthesia and analgesia in those with pre-existing CNS illnesses may be less prevalent than previously thought.