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MS and Anaesthesia – Suxamethonium Avoidance — SCE Neurology MCQ

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ModerateMultiple Sclerosis & CNS InflammationMS and Anaesthesia – Suxamethonium AvoidanceSCE Neurology

A 35-year-old woman with known MS on ocrelizumab is about to undergo general anaesthesia for an elective procedure. Her anaesthetic team asks about any specific considerations. What should they be advised about MS and anaesthesia?

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Correct answer: C — Avoid depolarising neuromuscular blocking agents (suxamethonium) — MS patients may have an exaggerated hyperkalaemic response; avoid hyperthermia intraoperatively (Uhthoff phenomenon risk); ensure PD medications are given on time if applicable

Specific anaesthetic considerations in MS include: (1) Suxamethonium (depolarising neuromuscular blocker) should be avoided as denervated muscles in MS can release excessive potassium, risking cardiac arrest. Non-depolarising agents (atracurium, rocuronium) are safe. (2) Hyperthermia should be avoided as it can worsen neurological symptoms (Uhthoff phenomenon). (3) Regional anaesthesia is not absolutely contraindicated in MS but requires careful documentation of pre-existing deficits. (4) The patient's DMT schedule should be maintained. A: There are important specific considerations. C: Regional anaesthesia is not absolutely contraindicated. D: GA is safe with appropriate precautions. E: Multiple agents are safe.

Reference: ABN MS Guidelines; Association of Anaesthetists MS Guidance