Pharmacologic Considerations during the Preoperative Evaluation of Neurologic Patients

Background: Optimizing a patient for surgery is a central goal during the preoperative period. Patients with common neurologic disorders, such as Alzheimer's disease, epilepsy, Parkinson's disease, and multiple sclerosis may require special attention in the perioperative management of their neurologic medications. Objective: This review aims to organize the most current recommendations for neurologic medication management during the perioperative period to minimize the risk of postoperative neurologic decline. Methods: A review of current literature present on PubMed and Medline of peer-reviewed research papers was conducted. The quality of the papers was assessed according to their research methodology and many of their sources were further analyzed in the same manner. A focused review question for each disease type was used, and, at times, inclusion and exclusion criteria were applied. Results: Manuscripts covered a wide range of medical subspecialties with the most common sources being anesthetic, neurologic, and pharmacologic journals. Conclusion: The systemic inflammation that occurs in the perioperative period is detrimental to a patient's neurologic status. It is important to recognize that the proper management of neurologic medications can limit the negative effects of these stresses on a patient. Most medications appear safe to continue until the morning of surgery. Consultation with a neurologist regarding continuation of specific medications may be necessary to further ensure patient safety.