Anaesthetic management of patient with neurological disease: Focus on regional anaesthesia

Anaesthesia of patients with neurological disease is feasible but each specific disease requires specific adjustments accordingly. A preoperative evaluation of neurological status is required and patients should be informed of the potential harms in the perioperative period. Regional anaesthesia is commonly considered as contraindicated in these patients although it is commonly not. General anaesthesia has not been demonstrated to worsen cognitive dysfunction in patients suffering from Alzheimer's disease but these dysfunctions may disturb postoperative rehabilitation. Regional anaesthesia has no special benefit in these patients. In patients with Parkinson's disease, inability to use the oral route in the postoperative period may impair the administration of the treatment. Multiple sclerosis is not a contraindication of epidural anaesthesia especially in obstetrics, since there is no evidence that it may trigger relapse of the disease especially in the postpartum period. Regional anaesthesia is doable in patients with a dysimmune demyelinoted lesions out of the regeneration phase of the disease. In peripheral hereditary or acquired neuropothies regional anaesthesia is also feasible. Epilepsy, spina bifida and traumatic pathologies of the spine are not contraindications to regional anaesthesia but the latter require technical adjustment.