Anesthesia in Patients with Select Neurological and Neuromuscular Disorders, A Scoping Review.

INTRODUCTION:
Patients with pre-existing neurological conditions, including prior stroke, epilepsy, paralysis, and Alzheimer's disease, are uniquely vulnerable in the perioperative setting for adverse outcomes. Stroke survivors face elevated risks of recurrent stroke, worsening deficits, and complications from comorbid conditions. Epilepsy patients require special considerations due to altered neuronal activity, susceptibility to intraoperative seizures, and interactions between anesthetics and antiseizure medications. Patients with Alzheimer's disease and related dementias are particularly susceptible to postoperative delirium and cognitive dysfunction. Those with neuromuscular disorders or paralysis face additional hazards, including hyperkalemia with succinylcholine and prolonged residual weakness with neuromuscular blockade. Although these risks are acknowledged, they are inconsistently considered in practice, and no standardized guidelines exist to inform pharmaceutical anesthetic management in these populations.

MAIN BODY:
This scoping review seeks to map and highlight knowledge gaps in anesthetic outcomes for these populations by contrasting recovery metrics with the general population and exploring the reported effects of anesthetic techniques and agents, thereby providing the foundation necessary for future guideline development. We structured a multi-database search on criteria for population, anesthetic modality, adverse events, and outcomes. Our preliminary review of relevant literature noted that anesthesia in patients with neurological disorders are at a notably higher risk for complications that can significantly impact health outcomes, that current protocols have failed to specifically address. Patients with epilepsy, paralysis, prior stroke, and Alzheimer's disease each exhibit distinct perioperative vulnerabilities compared with general surgical cohorts. Epilepsy is associated with higher rates of postoperative delirium, cognitive dysfunction, delayed emergence, and readmission. Paralysis confers greater risk of cardiovascular instability, hyperkalemia with neuromuscular blockade, and ICU utilization. Stroke history predicts increased perioperative stroke, major complications, mortality, prolonged hospitalization, and discharge to higher levels of care. Alzheimer's disease is linked to greater postoperative cognitive decline, aspiration risk, unpredictable anesthetic responses, and reduced likelihood of returning to baseline function. These higher incidents of complications all represent potential areas of progress that tailored anesthesia protocols could target.

CONCLUSION:
Our review concluded that there is a clinically significant disparity in the occurrence and severity of multiple anesthesia related side effects between patients with select neurological disorders and the general patient population. Our review aims to provide an overview of relevant literature to highlight the gaps in current research and spark further progress in the creation of guidelines for pharmaceutical anesthesia management in patient populations with neurological and neuromuscular disorders.