LAUSR

Neurological diseases are not uncommon, exhibiting a lifetime prevalence of 6% in the general population being even higher among elderly. The trend of the most common neurological disorders (cerebrovascular disease, Parkinson, dementia, epilepsy) for presentation at older ages, the increasing need of elderly for surgery (of any type) and the demographic aging of the population result in higher rates of neurological cases among patients undergoing surgery, especially the elderly. Perioperative management of neurological patients is a clinical challenge, demanding the active participation of several medical experts for better handling of the multiple specific and complex medical issues accompanying surgery in patients with known neurological disease. The appropriate adjustment of the neurological treatment (before, during and after surgery), the selection of the optimal anesthetic technique and regimens, the need for additional or specific preoperative tests, consultations or interventions, are only some of those issues. Moreover, the frequent presence of various comorbidities and the multisystem and multiorgan involvement characterizing particular neurological disorders such as Parkinson and neuromuscular diseases, necessitate a multidisciplinary approach in their handling. Literature publications on the issue have mostly focused on the role of anesthesiologist and neurologist in the perioperative management of neurological patients, frequently overlooking the role of surgeon. However, surgeon has a central and crucial position in this process, not limited to the performance of the operation and the handling of particular surgical complications (e.g. bleeding, wound infections). The main medical issues requiring surgeon’s participation are listed in Table 1 and analyzed in the following paragraphs. Preoperatively, for elected surgery, surgeon determines the optimal time of operation in cooperation with the neurologist and the other experts involved in the preoperative assessment of the patient, providing the necessary time interval for stabilization and improvement (if feasible) of the neurological disorder, or the completion of neurological assessment and investigation (for recently diagnosed cases). Other medical issues attributable either to the surgical problem or to existing comorbidities should be revealed and appropriately regulated before surgery: Anemia, malnutrition, fluid and electrolyte or metabolic abnormalities, hypertension, presence of active or subclinical infections (respiratory, urinary, etc.) not only c i r e s p . 2 0 1 7 ; x x ( x x ) : x x x – x x x