Preoperative Evaluation of Patients With Neurological Disease

Kathrin Lieb, MD; Magdy H. Selim, MD, PhD

Disclosures

Semin Neurol. 2008;28(5):603-610. 

In This Article

Abstract and Introduction

Abstract

A thorough evaluation of patients with neurological diseases undergoing surgery can reduce perioperative morbidity and mortality, especially stroke. Various neurological disorders and neurosurgical procedures may influence the nature and extent of preoperative evaluation, selection and conduct of anesthesia, and perioperative management and care. Although anesthesiologists primarily perform a preoperative evaluation of neurological patients, neurologists can contribute further valuable information about the neurological condition and perioperative management of various neurological diseases to obtain the best possible outcome. This article outlines the basic elements of preoperative evaluation and highlights specific considerations for neurological patients undergoing surgery.

Introduction

Neurological patients tend to be older and sicker than their nonneurological counterparts. As the population ages, the number of elderly patients with comorbid neurological conditions undergoing various surgical procedures is expected to increase. A thorough preoperative evaluation is important, as it allows careful assessment of the patient's overall health status, stratifying his or her perioperative risk, determining if further tests, consultations or treatments are needed to optimize the patient's health before surgery, and planning the most appropriate management to ultimately reduce perioperative morbidity and mortality.[1]

Preoperative evaluation of patients with preexisting neurological conditions undergoing nonneurological surgery and patients undergoing neurosurgery involves a thorough clinical assessment and diagnostic workup to determine the cause and extent of the patient's condition, and to ensure that the patient's comorbid conditions are under appropriate medical therapy, especially prior to elective procedures. Neurological and neurosurgical patients represent a heterogeneous population. The preexisting neurological disease may impact preoperative management and preparation for the surgical procedure, the choice of anesthetic agents and techniques, and the perioperative care. Optimal perioperative care requires an understanding of the pathophysiology of each patient's neurological condition. In this article, strategies for performing a complete preoperative evaluation in neurological and neurosurgical patients are discussed, and special considerations for perioperative management of specific neurological conditions to minimize morbidity and mortality are highlighted.

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