[Sevoflurane anesthesia in a patient with multiple sclerosis].

Abstract

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.