Title:Pharmacologic Considerations during the Preoperative Evaluation of Neurologic Patients
VOLUME: 12 ISSUE: 3
Author(s):Christian Mabry*
Affiliation:Department of Anesthesiology, Perioperative Care and Pain Medicine, NYU Langone Health, NYU School of Medicine, 550 1st Avenue, New York, NY 10016
Keywords:Alzheimer's disease, acetylcholinesterase inhibitors, N-methyl-D-aspartate (NMDA) receptor antagonists, epilepsy,
gamma-aminobutyric acid (GABA) receptor agonists, phenytoin, topiramate, carbamazepine, valproic acid, primidone, Parkinson's
disease, carbidopa, levodopa, dopamine agonists, monoamine oxidase inhibitors, amantadine, multiple sclerosis, monoclonal
antibodies.
Abstract:Background: Optimizing a patient for surgery is a central goal during the preoperative
period. Patients with common neurologic disorders, such as Alzheimer's disease, epilepsy, Parkinson's
disease, and multiple sclerosis may require special attention in the perioperative management
of their neurologic medications.
Objective: This review aims to organize the most current recommendations for neurologic medication
management during the perioperative period to minimize the risk of postoperative neurologic
decline.
Methods: A review of current literature present on PubMed and Medline of peer-reviewed research
papers was conducted. The quality of the papers was assessed according to their research methodology
and many of their sources were further analyzed in the same manner. A focused review question
for each disease type was used, and, at times, inclusion and exclusion criteria were applied.
Results: Manuscripts covered a wide range of medical subspecialties with the most common
sources being anesthetic, neurologic, and pharmacologic journals.
Conclusion: The systemic inflammation that occurs in the perioperative period is detrimental to a
patient's neurologic status. It is important to recognize that the proper management of neurologic
medications can limit the negative effects of these stresses on a patient. Most medications appear
safe to continue until the morning of surgery. Consultation with a neurologist regarding continuation
of specific medications may be necessary to further ensure patient safety.
