The majority of people with MS are young, otherwise healthy adults, whose risks during elective surgical procedures are about the same as the general population. MS is generally not a reason to avoid having surgery.
Most people with MS can tolerate standard anesthesia without undue risk. Special consideration may have to be made for the minority of people with MS who are severely disabled or have respiratory problems.
There is no evidence that the stress of surgery will bring on an exacerbation of MS. An exacerbation-also known as an attack, relapse, or flare-is a sudden worsening of an MS symptom or symptoms, or the appearance of new symptoms, which lasts at least 24 hours and is separated from a previous exacerbation by at least one month.
Generally, in the absence of complications, people with MS who undergo surgery do not find that it impacts their neurologic status. Infection or fever, however, may tend to aggravate symptoms of MS. Additionally, patients who have muscle weakness and who have been confined to bed for more than several days, may find it harder to recover from surgery. Physical therapy is often useful in these instances, and should be started as soon after surgery as recommended by a physician.
Anesthesia is the loss of pain or other sensation. There are four broad categories of anesthesia given to patients.
- General anesthesia, which is used for extensive surgeries or when other types of anesthesia aren't appropriate, involves putting a person to sleep, generally with a drug that is given intravenously or inhaled. The drugs used in general anesthesia act as hypnotics, painkillers, and muscle relaxants. They also block a person's memory of the surgery
- Conscious sedation, which induces an altered state of consciousness that minimizes pain and discomfort through the use of pain relievers and sedatives, allows the patient to speak and respond to verbal cues throughout the procedure, although he or she may not remember any of what occurs.
- Regional anesthesia, which is used to block sensation in a particular region of the body, is injected around a single nerve or network or nerves that serves the area. For example, epidural anesthesia, which is injected into or near the spinal fluid, numbs the nerves that serve the lower half of the body with impacting memory or awareness.
- Local anesthetics, such as those used in dental procedures or to stitch a cut, are introduced into a specific part of the body so that sensation in that portion is blocked, but the patient remains fully awake and aware.
Risks Are Generally Not Greater for Persons with MS
As a rule, the risks of general anesthesia for persons with MS are about the same as those for other people. The exceptions to this primarily involve the small percentage of MS patients with severe, advanced disease, who may be seriously weakened by MS or have respiratory problems that would put them at greater risk for anesthetic complications.
There is no reason for a person with MS to avoid local anesthesia when needed, unless the person happens to be allergic to the commonly used local anesthetics, such as Novocaine. One study reviewed 98 patients who together had received more than 1,000 doses of local anesthetics. In only four instances was the dose followed by an exacerbation—a sudden worsening of an MS symptom or symptoms. An exacerbation is also known as a relapse, attack, or flare.
Risks Among Women with MS During Labor and Delivery
All forms of anesthesia are considered safe for women with MS; anesthesia management does not need to be altered.