Neurological diseases are prevalent in the general population, and the neurohospitalist has an important role to play in the preoperative planning for patients with and at risk for developing neurological disease. The neurohospitalist can provide patients and their families as well as anesthesiologists, surgeons, hospitalists, and other providers guidance in particular to the patient’s neurological disease and those he or she is at risk for. Here we present considerations and guidance for the neurohospitalist providing preoperative consultation for the neurological patient with or at risk of disturbances of consciousness, cerebrovascular and carotid disease, epilepsy, neuromuscular disease, and Parkinson disease.
MacDonaldBKCockerellOCSanderJWShorvonSD. The incidence and lifetime prevalence of neurological disorders in a prospective community-based study in the UK. Brain. 2000;123(pt 4):665–676.
2.
HirtzDGGilbertPRTerrillCMBuckmanSY. Clinical trials in children--How are they implemented?Pediatr Neurol. 2006;34(6):436–438.
3.
Association. AP. and Statistical Manual of Mental Disorders. DSM-IV-TR, 4th ed. text revision. Washington, DC: American Psychiatric Association; 2000.
4.
InouyeS. Delirium in older persons. N Engl J Med. 2006;354(11):1157–1165.
5.
AllenSRFrankelHL. Postoperative complications: delirium. Surg Clin North Am. 2012;92(2):409–431.
6.
LeslieDLMarcantonioERZhangYLeo-SummersLInouyeSK. One-year health care costs associated with delirium in the elderly population. Arch Intern Med. 2008;168(1):27–32.
7.
DyerCBAshtonCMTeasdaleTA. Postoperative delirium. A review of 80 primary data-collection studies. Arch Intern Med. 1995;155(5):461–465.
8.
GottesmanRFGregaMABaileyMMDelirium after coronary artery bypass graft surgery and late mortality. Ann Neurol. 2010;67(3):338–344.
9.
MarcantonioERGoldmanLMangioneCMA clinical prediction rule for delirium after elective noncardiac surgery. JAMA. 1994;271(2):134–139.
10.
InouyeSK. Predisposing and precipitating factors for delirium in hospitalized older patients. Dement Geriatr Cogn Disord. 1999;10(5):393–400.
11.
InouyeSKBogardusSTJrCharpentierPAA multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med. 1999;340(9):669–676.
12.
DasguptaMDumbrellACNoimarkDPreoperative risk assessment for delirium after noncardiac surgery: a systematic review. J Am Geriatr Soc. 2006;54(10):1578–1589.
13.
NoimarkD. Predicting the onset of delirium in the post-operative patient. Age Ageing. 2009;38(4):368–373.
14.
RudolphJLJonesRNLevkoffSEDerivation and validation of a preoperative prediction rule for delirium after cardiac surgery. Circulation. 2009;119(2):229–236.
15.
KalisvaartKJVreeswijkRde JongheJFRisk factors and prediction of postoperative delirium in elderly hip-surgery patients: implementation and validation of a medical risk factor model. J Am Geriatr Soc. 2006;54(5):817–822.
LefevreFWoolgerJM. Surgery in the patient with neurologic disease. Med Clin North Am. 2003;87(1):257–271.
18.
SchiaviAPapangelouAMirskiM. Preoperative preparation of the surgical patient with neurologic disease. Anesthesiol Clin. 2009;27(4):779–786.
19.
CleggAYoungJB. Which medications to avoid in people at risk of delirium: a systematic review. Age Ageing. 2011;40(1):23–29.
20.
TuneLCarrSHoagECooperT. Anticholinergic effects of drugs commonly prescribed for the elderly: potential means for assessing risk of delirium. Am J Psychiatry. 1992;149(10):1393–1394.
21.
LiebKSelimM. Preoperative evaluation of patients with neurological disease. Semin Neurol. 2008;28(5):603–610.
22.
BlumDMaldonadoJMeyerELansbergM. Delirium following abrupt discontinuation of fluoxetine. Clin Neurol Neurosurg. 2008;110(1):69–70.
23.
RubinFHWilliamsJTLescisinDAReplicating the hospital elder life program in a community hospital and demonstrating effectiveness using quality improvement methodology. J Am Geriatr Soc. 2006;54(6):969–974.
24.
WongGYWarnerDOSchroederDRRisk of surgery and anesthesia for ischemic stroke. Anesthesiology. 2000;92(2):425–432.
25.
BuceriusJGummertJFBorgerMAStroke after cardiac surgery: a risk factor analysis of 16,184 consecutive adult patients. Ann Thorac Surg. 2003;75(2):472–478.
26.
LimburgMWijdicksEFLiH. Ischemic stroke after surgical procedures: clinical features, neuroimaging, and risk factors. Neurology. 1998;50(4):895–901.
27.
RestrepoLWitykRJGregaMADiffusion- and perfusion-weighted magnetic resonance imaging of the brain before and after coronary artery bypass grafting surgery. Stroke. 2002;33(12):2909–2915.
28.
BrookerRFBrownWRMoodyDMCardiotomy suction: a major source of brain lipid emboli during cardiopulmonary bypass. Ann Thorac Surg. 1998;65(6):1651–1655.
29.
NaylorARMehtaZRothwellPMBellPR. Carotid artery disease and stroke during coronary artery bypass: a critical review of the literature. Eur J Vasc Endovasc Surg. 2002;23(4):283–294.
30.
LikoskyDSMarrinCACaplanLRDetermination of etiologic mechanisms of strokes secondary to coronary artery bypass graft surgery. Stroke. 2003;34(12):2830–2834.
31.
SelimM. Perioperative stroke. N Engl J Med. 2007;356(7):706–713.
32.
KamPCCalcroftRM. Peri-operative stroke in general surgical patients. Anaesthesia. 1997;52(9):879–883.
33.
NosanDKGomezCRMavesMD. Perioperative stroke in patients undergoing head and neck surgery. Ann Otol Rhinol Laryngol. 1993;102(9):717–723.
34.
HogueCWJrMurphySFSchechtmanKBDavila-RomanVG. Risk factors for early or delayed stroke after cardiac surgery. Circulation. 1999;100(6):642–647.
35.
HinterhuberGBohlerKKittlerHQuehenbergerP. Extended monitoring of hemostatic activation after varicose vein surgery under general anesthesia. Dermatol Surg. 2006;32(5):632–639.
36.
KaireviciuteDAidietisALipGY. Atrial fibrillation following cardiac surgery: clinical features and preventative strategies. Eur Heart J. 2009;30(4):410–425.
37.
RhoRW. The management of atrial fibrillation after cardiac surgery. Heart. 2009;95(5):422–429.
38.
DixonBSantamariaJCampbellD. Coagulation activation and organ dysfunction following cardiac surgery. Chest. 2005;128(1):229–236.
39.
ParamoJARifonJLlorensRCasaresJPalomaMJRochaE. Intra- and postoperative fibrinolysis in patients undergoing cardiopulmonary bypass surgery. Haemostasis. 1991;21(1):58–64.
40.
GutierrezIZBaroneDLMakulaPACurrierC. The risk of perioperative stroke in patients with asymptomatic carotid bruits undergoing peripheral vascular surgery. Am Surg. 1987;53(9):487–489.
41.
BondRRerkasemKShearmanCPRothwellPM. Time trends in the published risks of stroke and death due to endarterectomy for symptomatic carotid stenosis. Cerebrovasc Dis. 2004;18(1):37–46.
42.
McKhannGMGregaMABorowiczLMJrBaumgartnerWASelnesOA. Stroke and encephalopathy after cardiac surgery: an update. Stroke. 2006;37(2):562–571.
43.
NewmanMFMathewJPGrocottHPCentral nervous system injury associated with cardiac surgery. Lancet. 2006;368(9536):694–703.
44.
CharlesworthDCLikoskyDSMarrinCADevelopment and validation of a prediction model for strokes after coronary artery bypass grafting. Ann Thorac Surg. 2003;76(2):436–443.
45.
LikoskyDSCaplanLRWeintraubRMIntraoperative and postoperative variables associated with strokes following cardiac surgery. Heart Surg Forum. 2004;7(4):E271–E276.
46.
EvansBAWijdicksEF. High-grade carotid stenosis detected before general surgery: is endarterectomy indicated?Neurology. 2001;57(7):1328–1330.
47.
GerratyRPGatesPCDoyleJC. Carotid stenosis and perioperative stroke risk in symptomatic and asymptomatic patients undergoing vascular or coronary surgery. Stroke. 1993;24(8):1115–1118.
48.
ChaturvediSBrunoAFeasbyTCarotid endarterectomy--an evidence-based review: report of the therapeutics and technology assessment subcommittee of the American Academy of neurology. Neurology. 2005;65(6):794–801.
49.
DasSKBrowTDPepperJ. Continuing controversy in the management of concomitant coronary and carotid disease: an overview. Int J Cardiol. 2000;74(1):47–65.
50.
MackeyAEAbrahamowiczMLangloisYOutcome of asymptomatic patients with carotid disease. Asymptomatic Cervical Bruit Study Group. Neurology.1997;48(4):896–903.
51.
MolloyJMarkusHS. Asymptomatic embolization predicts stroke and TIA risk in patients with carotid artery stenosis. Stroke. 1999;30(7):1440–1443.
52.
SoinneLHeleniusJTatlisumakTCerebral hemodynamics in asymptomatic and symptomatic patients with high-grade carotid stenosis undergoing carotid endarterectomy. Stroke. 2003;34(7):1655–1661.
53.
SharonyRGrossiEASaundersPCPropensity case-matched analysis of off-pump coronary artery bypass grafting in patients with atheromatous aortic disease. J Thorac Cardiovasc Surg. 2004;127(2):406–413.
54.
MaulazABBezerraDCMichelPBogousslavskyJ. Effect of discontinuing aspirin therapy on the risk of brain ischemic stroke. Arch Neurol. 2005;62(8):1217–1220.
55.
GeneweinUHaeberliAStraubPWBeerJH. Rebound after cessation of oral anticoagulant therapy: the biochemical evidence. Br J Haematol. 1996;92(2):479–485.
56.
KitchenLErichsonRBSideropoulosH. Effect of drug-induced platelet dysfunction on surgical bleeding. Am J Surg. 1982;143(2):215–217.
57.
MichelsonELMorganrothJTorosianMMac VaughH3rd. Relation of preoperative use of aspirin to increased mediastinal blood loss after coronary artery bypass graft surgery. J Thorac Cardiovasc Surg. 1978;76(5):694–697.
58.
FerrarisVASwansonE. Aspirin usage and perioperative blood loss in patients undergoing unexpected operations. Surg Gynecol Obstet. 1983;156(4):439–442.
59.
HorlockerTTWedelDJSchroederDRPreoperative antiplatelet therapy does not increase the risk of spinal hematoma associated with regional anesthesia. Anesth Analg. 1995;80(2):303–309.
60.
GavaghanTPGebskiVBaronDW. Immediate postoperative aspirin improves vein graft patency early and late after coronary artery bypass graft surgery. A placebo-controlled, randomized study. Circulation. 1991;83(5):1526–1533.
61.
ManganoDT. Aspirin and mortality from coronary bypass surgery. N Engl J Med. 2002;347(17):1309–1317.
62.
LindbladBPerssonNHTakolanderRBergqvistD. Does low-dose acetylsalicylic acid prevent stroke after carotid surgery? A double-blind, placebo-controlled randomized trial. Stroke.1993;24(8):1125–1128.
63.
TaylorDWBarnettHJHaynesRBLow-dose and high-dose acetylsalicylic acid for patients undergoing carotid endarterectomy: a randomised controlled trial. ASA and Carotid Endarterectomy (ACE) Trial Collaborators. Lancet.1999;353(9171):2179–2184.
64.
YusufSZhaoFMehtaSRChrolaviciusSTognoniGFoxKK. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med. 2001;345(7):494–502.
65.
PatsalosPNPeruccaE. Clinically important drug interactions in epilepsy: interactions between antiepileptic drugs and other drugs. Lancet Neurol. 2003;2(8):473–481.
66.
EngelterSLyrerP.Antiplatelet therapy for preventing stroke and other vascular events after carotid endarterectomy. Cochrane Database Syst Rev. 2003;(3):CD001458.
67.
DunnASTurpieAG. Perioperative management of patients receiving oral anticoagulants: a systematic review. Arch Intern Med. 2003;163(8):901–908.
68.
LarsonBJZumbergMSKitchensCS. A feasibility study of continuing dose-reduced warfarin for invasive procedures in patients with high thromboembolic risk. Chest. 2005;127(3):922–927.
69.
DunnASWisniveskyJHoWMooreCMcGinnTSacksHS. Perioperative management of patients on oral anticoagulants: a decision analysis. Med Decis Making. 2005;25(4):387–397.
70.
BonowROCarabelloBde LeonACACC/AHA guidelines for the management of patients with valvular heart disease. Executive summary. A report of the American college of cardiology/American heart association task force on practice guidelines (Committee on management of patients with valvular heart disease). J Heart Valve Dis.1998;7(6):672–707.
71.
DouketisJD. Perioperative anticoagulation management in patients who are receiving oral anticoagulant therapy: a practical guide for clinicians. Thromb Res. 2002;108(1):3–13.
72.
HauserWAAnnegersJFKurlandLT. Incidence of epilepsy and unprovoked seizures in Rochester, Minnesota: 1935-1984. Epilepsia. 1993;34(3):453–468.
73.
NiesenADJacobAKAhoLEPerioperative seizures in patients with a history of a seizure disorder. Anesth Analg. 2010;111(3):729–735.
74.
SpechtUElsnerHMayTWSchimichowskiBThorbeckeR. Postictal serum levels of antiepileptic drugs for detection of noncompliance. Epilepsy Behav. 2003;4(5):487–495.
75.
ManclEEGidalBE. The effect of carbapenem antibiotics on plasma concentrations of valproic acid. Ann Pharmacother. 2009;43(12):2082–2087.
76.
Johannessen LandmarkCPatsalosPN. Drug interactions involving the new second- and third-generation antiepileptic drugs. Expert Rev Neurother. 2010;10(1):119–140.
77.
ChambersHGWeinsteinCHMubarakSJWengerDRSilvaPD. The effect of valproic acid on blood loss in patients with cerebral palsy. J Pediatr Orthop. 1999;19(6):792–795.
78.
Pohlmann-EdenBPetersCNWennbergRDempfleCE. Valproate induces reversible factor XIII deficiency with risk of perioperative bleeding. Acta Neurol Scand. 2003;108(2):142–145.
79.
WardMMBarbaroNMLaxerKDRampilIJ. Preoperative valproate administration does not increase blood loss during temporal lobectomy. Epilepsia. 1996;37(1):98–101.
80.
AndersonGDLinYXBergeCOjemannGA. Absence of bleeding complications in patients undergoing cortical surgery while receiving valproate treatment. J Neurosurg. 1997;87(2):252–256.
81.
PsarasTWillBESchoeberWRonaSMittelbronnMHoneggerJB. Quantitative assessment of postoperative blood collection in brain tumor surgery under valproate medication. Zentralbl Neurochir. 2008;69(4):165–169.
82.
IchikawaJNishiyamaKOzakiKIkedaMTakiiYOzakiM. Anesthetic management of a pediatric patient on a ketogenic diet. J Anesth. 2006;20(2):135–137.
83.
ValenciaIPfeiferHThieleEA. General anesthesia and the ketogenic diet: clinical experience in nine patients. Epilepsia. 2002;43(5):525–529.
84.
KofkeWA. Anesthetic management of the patient with epilepsy or prior seizures. Curr Opin Anaesthesiol. 2010;23(3):391–399.
85.
PerksACheemaSMohanrajR. Anaesthesia and epilepsy. Br J Anaesth. 2012;108(4):562–571.
86.
ModicaPATempelhoffRWhitePF. Pro- and anticonvulsant effects of anesthetics (Part I). Anesth Analg. 1990;70(3):303–315.
87.
ReddyRVMoorthySSDierdorfSFDeitchRDJrLinkL. Excitatory effects and electroencephalographic correlation of etomidate, thiopental, methohexital, and propofol. Anesth Analg. 1993;77(5):1008–1011.
88.
KoppSLWyndKPHorlockerTTHeblJRWilsonJL. Regional blockade in patients with a history of a seizure disorder. Anesth Analg. 2009;109(1):272–278.
89.
BenishSMCascinoGDWarnerMEWorrellGAWassCT. Effect of general anesthesia in patients with epilepsy: a population-based study. Epilepsy Behav. 2010;17(1):87–89.
90.
ReuberMEnrightSMGouldingPJ. Postoperative pseudostatus: not everything that shakes is epilepsy. Anaesthesia. 2000;55(1):74–78.
91.
ChangCCHuCJLamFChangHLiaoCCChenTL. Postoperative adverse outcomes in surgical patients with epilepsy: a population-based study. Epilepsia. 2012;53(6):987–994.
92.
McAlisterFAKhanNAStrausSEAccuracy of the preoperative assessment in predicting pulmonary risk after nonthoracic surgery. Am J Respir Crit Care Med. 2003;167(5):741–744.
93.
AmbrosinoNCarpeneNGherardiM. Chronic respiratory care for neuromuscular diseases in adults. Eur Respir J. 2009;34(2):444–451.
LacomisDGiulianiMJVan CottAKramerDJ. Acute myopathy of intensive care: clinical, electromyographic, and pathological aspects. Ann Neurol. 1996;40(4):645–654.
96.
Van den BergheGSchoonheydtKBecxPBruyninckxFWoutersPJ. Insulin therapy protects the central and peripheral nervous system of intensive care patients. Neurology. 2005;64(8):1348–1353.
97.
NeedhamDM. Mobilizing patients in the intensive care unit: improving neuromuscular weakness and physical function. JAMA. 2008;300(14):1685–1690.
98.
RosenbaumKJNeighJLStrobelGE. Sensitivity to nondepolarizing muscle relaxants in amyotrophic lateral sclerosis: report of two cases. Anesthesiology. 1971;35(6):638–641.
99.
AntogniniJF. Anaesthesia for Charcot-Marie-Tooth disease: a review of 86 cases. Can J Anaesth. 1992;39(4):398–400.
100.
PogsonDTelferJWimbushS. Prolonged vecuronium neuromuscular blockade associated with Charcot Marie Tooth neuropathy. Br J Anaesth. 2000;85(6):914–917.
101.
NaguibMSamarkandiAH. Response to atracurium and mivacurium in a patient with Charcot-Marie-Tooth disease. Can J Anaesth. 1998;45(1):56–59.
102.
SchmittHJMunsterT. Mivacurium-induced neuromuscular block in adult patients suffering from Charcot-Marie-Tooth disease. Can J Anaesth. 2006;53(10):984–988.
103.
JenkinsJGBohnDEdmondsJFLevisonHBarkerGA. Evaluation of pulmonary function in muscular dystrophy patients requiring spinal surgery. Crit Care Med. 1982;10(10):645–649.
104.
GurnaneyHBrownALitmanRS. Malignant hyperthermia and muscular dystrophies. Anesth Analg. 2009;109(4):1043–1048.
105.
RirieDGShapiroFSethnaNF. The response of patients with Duchenne's muscular dystrophy to neuromuscular blockade with vecuronium. Anesthesiology. 1998;88(2):351–354.
106.
MathieuJAllardPGobeilGGirardMDe BraekeleerMBeginP. Anesthetic and surgical complications in 219 cases of myotonic dystrophy. Neurology. 1997;49(6):1646–1650.
107.
Colding-JorgensenE. Phenotypic variability in myotonia congenita. Muscle Nerve. 2005;32(1):19–34.
108.
UrbanM LS. Muscle Disease. In: L F, ed. Anesthesia and Uncommon Diseases. Philadelphia, PA: Saunders Elsevier; 2006:303–325.
109.
Blichfeldt-LauridsenLHansenBD. Anesthesia and myasthenia gravis. Acta Anaesthesiol Scand. 2012;56(1):17–22.
110.
BertonliniTE LYBassamBAMitchellCW. Perioperative management of patients with neuromuscular disorders. Neuromuscular Disorders Treatment and Management. Philadelphia, PA: Saunders Elsevier; 2011:155–166.
DorseyERConstantinescuRThompsonJPProjected number of people with Parkinson disease in the most populous nations, 2005 through 2030. Neurology. 2007;68(5):384–386.
116.
PrashanthLKFoxSMeissnerWGl-Dopa-induced dyskinesia-clinical presentation, genetics, and treatment. Int Rev Neurobiol. 2011;98:31–54.
TagliatiMJankovicJPaganFSusatiaFIsaiasIUOkunMS. Safety of MRI in patients with implanted deep brain stimulation devices. Neuroimage. 2009;47(suppl 2):T53–T57.
119.
ZrinzoLYoshidaFHarizMIClinical safety of brain magnetic resonance imaging with implanted deep brain stimulation hardware: large case series and review of the literature. World Neurosurg. 2011;76(1-2):164–172.
120.
RezaiARFinelliDNyenhuisJANeurostimulation systems for deep brain stimulation: in vitro evaluation of magnetic resonance imaging-related heating at 1.5 tesla. J Magn Reson Imaging. 2002;15(3):241–250.
121.
NewmanEJGrossetDGKennedyPG. The parkinsonism-hyperpyrexia syndrome. Neurocrit Care. 2009;10(1):136–140.
122.
HollandJ. Care of patients with Parkinson's disease in the operating department. J Perioper Pract. 2010;20(11):406–410.
123.
WullnerUKassubekJOdinPTransdermal rotigotine for the perioperative management of Parkinson's disease. J Neural Transm. 2010;117(7):855–859.
124.
NuttJGWoodwardWR. Levodopa pharmacokinetics and pharmacodynamics in fluctuating parkinsonian patients. Neurology. 1986;36(6):739–744.
125.
HuyseFJTouwDJvan SchijndelRSde LangeJJSlaetsJP. Psychotropic drugs and the perioperative period: a proposal for a guideline in elective surgery. Psychosomatics. 2006;47(1):8–22.
126.
MariscalAHernandez MedranoIAlonso CanovasAPerioperative management of Parkinson's disease. Cir Esp. 2011;89(7):427–431.
127.
PepperPVGoldsteinMK. Postoperative complications in Parkinson's disease. J Am Geriatr Soc. 1999;47(8):967–972.
128.
RobottomBJShulmanLMAndersonKEWeinerWJ. Metoclopramide-induced encephalopathy in Parkinson disease. South Med J. 2010;103(2):178–180.
129.
LoiseauP. Sodium valproate, platelet dysfunction, and bleeding. Epilepsia. 1981;22(2):141–146.
130.
SandlerRMEmbersonCRobertsGEVoakDDarnboroughJHeeleyAF. IgM platelet autoantibody due to sodium valproate. Br Med J. 1978;2(6153):1683–1684.
131.
KreuzWLindeRFunkMValproate therapy induces von Willebrand disease type I. Epilepsia. 1992;33(1):178–184.
132.
JeavonsPMClarkJE. Sodium valproate in treatment of epilepsy. Br Med J. 1974;2(5919):584–586.
