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Multiple sclerosis (Intraop (Musculoskeletal (weakness, spasticity,…

- - - - May require ventilation
      - Monitor vital capacity
      - Incentive spirometry
      - Chest physio
      - Postural drainage
      - Early mobilisation
    - - Infection (change IV lines every 48hrs)
      - Emotional stress
      - Fever
    - - Multimodal
      - Regional can be used (may reduce need for postop opioids and improve ventilation
      - Thermoregulation
- - - - Level of neurologic deficit
        
        Motor weakness (bulbar, resp, exercise tolerance)
        
        Visual impairment
        
        Ataxia
        
        Bladder and bowel dysfunction: may indicate autonomic dysfunction
        
        Pain/parasthesia
        
        Emotional lability
      - Precipitating factors - heat, infection, fever (Uhtoff's phenomenon), stress, exercise
      - History of:
        
        Prolonged weakness after anaesthesia
        
        Pneumonia (weakness of bulbar and resp muscles)
      - Treatment
        
        Corticosteroids and other immunosupressants
        
        For relapses (does not impact disease progression)
        
        SE in pregnancy: maternal glucose intollerance and neonatal adrenal suppression
        
        If >15mg Pred - may need supplementation depending on intervention
        
        Interferon B and glatiramer (polymer myelin basic protein) - reduces frequency of relapses
        
        Symptomatic: Spasticity (Baclofen), Fatigue (amantadine), Depression (antidepressant), Neurogenic bladder (anticholinergics, intermittent catheterisation)
    - - Resp - signs of infection
      - Neuro - describe defects explicitly
    - - BSL - if on steroids
      - Resp function test for severely affected patients: may be useful in predicting need for postop mech vent.
    - - Risk of post op relapse, regardless of type of anaesthesia used
      - That anaesthesia does not have a negative influence on the long term course of disease
    - - Premed: avoid opioids and sedatives, consider antacid
      - Continue corticosteroid