Perioperative management of neurological and psychiatric conditions

Patients with neurological disease may present for surgery as a result of their neurological disease or for an unrelated condition. Underlying neurological disease has important implications for perioperative management regardless of the reason for surgery. This review discusses common neurological conditions (e.g. cerebrovascular disease, stroke, epilepsy, Parkinson's disease, dementia, depression, multiple sclerosis) that may be encountered. The diverse nature of neurological disease results in diverse clinical manifestations. Depression of the CNS, motor neuropathies, disorders of the neuromuscular junction and injuries to the spinal cord may significantly impair respiratory function. Autonomic neuropathy is a feature of many neurological conditions and results in marked vasomotor instability in response to sympathetic stimulation, postural change, blood loss, etc. Patients with neurological disease are at increased risk of deep venous thrombosis due to immobility. If raised intracranial pressure is suspected, elective surgery should not be undertaken until appropriate investigation has taken place.