Subject: Anesthetic for Pending Surgery for MSA (SDS) Patient

[Guest guest]

Hi all: this was posted once before, but now that we've been talking about surgery and MSA. I think it should be posted again.

It was a question that Marie Fox asked on the Neurology forum. I think it was Pam that posted it last time and I think it's may help the newbies on the list.

Take Care

Vera

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Subject: Anesthetic for Pending Surgery for MSA (SDS) Patient

Topic Area: Pain

Forum: The Neurology and Neurosurgery Forum

Question Posted By: Marie Fox on Monday, June 16, 1997

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Posted by CCF NEURO MD on June 26, 1997 at 10:42:09:

In Reply to: Anesthetic for Pending Surgery for MSA (SDS) Patient posted by Marie Fox on June 16, 1997 at 16:12:27:

: Dear Doctors:My husband was diagnosed with Parkinson's Disease in 1987 and rediagnosed

with Multiple Systems Atrophy (SDS) in August of 1996. His major problems

have been orthostatic hypotension resulting in frequent falls, urinary

dysfunction and constipation. He is currently on the following medicines:

midodrine (proamatine), florinef, sinemet, sinemet CR, peroxicam (feldene),

amantadine (symmetryl), a multivitamin, aspirin (1/day - preventive), and

Vitamin E. He also takes stool softeners, stool softeners w/laxative,

Dulcolax, Senekot, and Milk of Magnesia. Occasionally we must resort to

suppositories and enemas.My question is - he will be having surgery to replace his knee replacement

a week from today. He damaged the replacement in a fall the end of January,

along with breaking his hip. The hip is mending nicely but the knee

is very painful - therefore the need for the surgery. Are any of the

medications he is currently taking dangerous in combination with any

anesthetic that might be given? We had quite a time the last time he

had his knee replaced because he was on eldepryl at that time and the

anesthesiologist said it would be life-threatening to have surgery while

on this drug. We had to postpone the surgery until eldepryl was out of

his system. He no longer takes it.Is there anything else we need to be careful of at this time?

Thanks for your help.Marie Fox

========================================================================================Dear Marie,

Eldepryl at the recommended doses is a a selective inhibitor of monoamine oxidase, type B. It has been recommended to avoid use of medications such as Prozac (fluoxetine), Demerol (meperidine),other opiods and other MOA inhibitors. Our movement disorder specialist, Dr. Stanely Burns, recommends that all patients be off eldepryl for at least two weeks prior to surgery, due to complications, most commonly mental status changes and hallucinations. In regards to the other drugs: midodrine it can cause supine hypertension heart rate slowing, the anesthesiologist should be aware of being on this medication; florinef is a corticosteroid and when used over a long period of time at high doses, may require an additional supportive dose in times of stress (such as surgery) to avoid drug induced adrenal insufficiency, at low doses it may not be a problem. Florinef may also cause hypertension. Feldene and Asprin will need to be discontinued prior to surgery due to their thinning affects on the blood (usually about 7 days). Ask your surgeon for the recommended time to be off of these. The rest of the medications have no adverse affect and may be held after midnight the day of your surgery and resumed as soon as he can swallow again. When you go for the preoperative anesthesia clearance, the anesthesiologist will review all your medications. It is best to bring the actual bottles of medications with you so they can check the dose. They will advise you of any additional adverse affects based on the type of anesthesia they plan to use. The information I have provided you is general medical educational information, it is best to consult your own primary physician for adverse reactions particular to your husbands case. I hope all goes well with your husband's surgery and I wish him a fast recovery.