MULTIPLE SCLEROSIS- ANESTHESIA IMPLICATIONS

# Most often, postop exacerbation, if it occurs is due to surgical complications like fever and infections

# Even minor increases in body temperatures are not tolerated well

# With the use of Suxamethonium, there is a risk of hyperkalemia

# Both resistance and prolongation of NMBA response are seen

# Complications have been reported with spinal anesthesia (Weak myelin sheath and direct neurotoxicity from LAs have been suggested as reason for this)

# Epidural is safe in this regard (As in epidural technique, there will be a lower concentration of LA in white matter)

# We should explain the chance of exacerbation of symptoms before any form of regional anesthesia

#multiplesclerosis , #anesthesia , #anaesthesia

A FEW FACTS ABOUT COAGULATION FUNCTION, IT’S MONITORING & #RegionalAnesthesia IN OBSTETRIC PATIENTS

🏳️🌈 During routine epidural or spinal anaesthesia, accidental puncture of epidural veins occurs in 1–18% of patients

🏳️🌈The incidence after epidural techniques is estimated to be in the order of 1:150,000 after epidural placement and 1:220,000 after spinal injection in the general population

🏳️🌈removal of epidural catheters posed an equal risk to insertion ( Van- dermeulen et al)

🏳️🌈Surgery on spinal haematoma should ideally be performed within 8–12 h of the identification of symptoms in order to improve the chances of recovery. 

🏳️🌈The overall risk of death in those having general anaesthesia for caesarean section was quoted in 2007 as being just over 1:25,000.

🏳️🌈The levels of factors VII, VIII and fibrinogen increase and those of anticoagulation factors decrease, causing augmented coagulation and decreased fibrinolysis.

🏳️🌈There is no evidence to support routine full blood count (FBC) or coagu lation tests in women before the performance of a regional block in those who have had  

🏴normal FBC results

🏴no bleeding history

🏴no signs or symptoms of liver disease

🏴no signs or symptoms of pre-eclampsia, abruption or clinical signs of disseminated intravascular coagulation

🏴no recent anticoagulant treatment.

🏳️🌈In women with known thrombocytopaenia, a Full Blood Count (FBC) should be checked within 24 h of a regional procedure. 

🏴In women with mild to moderate pre-eclampsia, the course of the disease can be unpredictable and so  FBC be checked within 6 h. In addition, coagulation tests should be performed if platelets are <100000/mcL or if there is abnormal liver function. 

🏴In severe disease, FBC and clotting should be checked immediately before a procedure, as platelet levels in particular can decline rapidly. 

🏴Women with pregnancy-induced hypertension alone do not require an FBC before a regional procedure

🏳️🌈Activated partial thromboplastin time ratio (APTTR) and international normalised ratio (INR) are slightly decreased in late pregnancy.

🏳️🌈In a patient who receives LMWH, if he/she is simultaneously taking NSAID+Aspirin, there is an increased risk if last dose of LMWH is between 12-24 hours; it further increases if last dose is <12 hours 

🏳️🌈In patients with pre-eclampsia and platelet count between 75000-100000/mcL, there is an increased risk even if coagulation tests are normal; but it increases further if the counts has not been stable (= decreasing platelet count)

#obstetrics , #anesthesia , #coagulation , #anaesthesia

Reference: Abnormalities of Coagulation and Obstetric Anaesthesia, Hilary Swales, AAGBI Core Topics in Anaesthesia 2015