Kohno K, Uchida H, Yamamoto N, Kosaka Y
Department of Anesthesiology, Masuda Red Cross Hospital.
Masui. 1994 Aug;43(8):1229-32.
Multiple sclerosis (MS) is a disorder of the nervous system in which myelin breakdown is a prominent feature. We report a 65-yr-old woman scheduled for femoral neck prosthetic replacement under sevoflurane anesthesia, who had been suffering from a progressive type of MS for 27 years. Previously she had a history of exacerbation of symptoms after caudal block done for sciatic neuralgia. Stress such as surgery, anesthesia, emotional distress and variable body temperature can exacerbate the disease. Spinal and epidural block are relatively contraindicated in MS. Thiopental was reported to worsen MS. But there is no evidence that any of the volatile anesthetic agents has a deleterious effect on MS. Sevoflurane can be used to induce anesthesia quickly. To avoid thiopental, we chose slow induction with sevoflurane (GOS). Anesthesia was maintained with GOS. It seems that intraoperative hypotension which resists to ephedrine administration is partly due to autonomic abnormality. Yet, there is no report of sevoflurane anesthesia in MS patient. We consider that in this case sevoflurane is a safe anesthetic because of its less effect on postopreative neurological symptoms than that of epidural block.
多发性硬化症（MS）是一种神经系统疾病，其突出特征是髓鞘破坏。我们报告一例65岁女性，患有进行性MS 27年，计划在七氟醚麻醉下进行股骨颈假体置换。此前她因坐骨神经痛行骶管阻滞术后有症状加重史。手术、麻醉、情绪困扰和体温变化等应激因素可使病情加重。MS患者相对禁忌使用脊髓和硬膜外阻滞。据报道硫喷妥钠会使MS病情恶化。但没有证据表明任何一种挥发性麻醉剂对MS有有害影响。七氟醚可快速诱导麻醉。为避免使用硫喷妥钠，我们选择用七氟醚（GOS）进行慢诱导。麻醉维持用GOS。术中对麻黄碱给药无反应的低血压似乎部分是由于自主神经异常。然而，尚无MS患者七氟醚麻醉的报道。我们认为在该病例中七氟醚是一种安全的麻醉剂，因为其对术后神经症状的影响比硬膜外阻滞小。
