Anesthetic Considerations for Patients with Chronic Neurologic Disorders

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Chronic neurological disorders encompass a broad range of challenges for the surgical and anesthesiology team in the perioperative setting. According to the World Population Prospects 2019, by 2050, 1 in 6 people will be over 65, from 1 in 11 in 2019 [1]. As our population continues to age, our understanding and ability to provide medical and surgical services must improve as well. Perioperative strokes are rare, but they can greatly impact a patient's recovery and function when they occur. Dementia strongly predicts postoperative complications, higher hospital costs, and 30- day mortality [2]. Patients with Parkinson’s disease are at a higher risk of perioperative medical and surgical complications not to mention specific medication regimens that need to be adjusted to avoid worsening symptomatology. Although rare, a patient presenting with Amyotrophic lateral sclerosis (ALS), can present with a broad range of neurologic symptoms, and cardiovascular and pulmonary dysfunction that can be daunting for any anesthesia provider. In this chapter, we will explore the comprehensive approach to managing chronic neurologic disorders, including multidisciplinary care, early identification of potential complications, specialized medication management, and intraoperative considerations.