Longnecker's Anesthesiology > Part 2. Preparing for Anesthesia > Section B. Preoperative Evaluation of the Anesthesia Patient > Chapter 10. Evaluation of the Patient with Neuropsychiatric Disease John Morris, MD, and Dell Burkey, MD

Key Points

"1. As the population ages, surgical patients with neuropsychiatric diseases will become more common. Older patients, even in the absence of diagnosed disease, may have a reduced "cognitive reserve."

2. Multiple sclerosis patients can safely undergo both general and conduction anesthesia. However, anesthesiologists should scrupulously avoid hyperthermia and prevent postoperative pain.

3. Patients with myasthenia gravis may benefit from an anesthetic technique that does not use muscle relaxants or volatile agents, such as a propofol-remifentanil total intravenous anesthetic.

4. Although it has traditionally been held that perioperative neuropathies resulted from preventable failures of patient positioning, particularly in courts of law, more recent data indicate that these injuries are multifactorial and not necessarily preventable.

5. The risk of autonomic hyperreflexia in chronic spinal cord injury patients mandates adequate anesthesia even for procedures below the level of injury.

6. Although there is concern that general anesthesia represents a risk factor for the development of Alzheimer's disease or a worsening of its symptoms, research is inconclusive. Furthermore, no conclusive advantage of regional over general anesthesia has been demonstrated.

7. Depression is a significant risk factor for..."