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Leprosy and anaesthesia : Peri-operative concerns in patients with Hansen's disease

Abstract
Leprosy is a chronic granulomatous disease caused by Mycobacterium leprae, with wide spread systemic manifestations. Its prevalence is high in the developing world and it is, in fact, a leading cause of severe neuropathy in the developing world. Hence, the likelihood of encountering leprosy patients in daily anesthesia practice is quite high. Despite this, literature pertaining to anaesthesia in leprosy patients is quite meagre. This article attempts to explore the available literature on leprosy relevant to anaesthesiologists, in order to substantiate recommendations for administering safe and effective anaesthesia in leprosy patients. A thorough pre-operative evaluation is required as leprosy affects almost all organ systems. Intra-operatively, induction and extubation must be smooth and stress response to airway management must be minimised. Nasal manipulations are preferably avoided. Before regional anaesthesia, proper documentation of nerves involved by the disease must be noted and blind nerve blocks must be abandoned. All pressure points and bony prominences must be padded. Special precaution must be taken in preventing hypothermia, neuropathy and myopathy. Drug interactions with anaesthetic agents should also be kept in mind. Social rehabilitation and psychological support during the entire perioperative period for these patients goes a long way in ensuring a successful operative outcome. As there are very few publications on use of different anaesthesia methods in these cases, emphasis should be to document and analyse the experiences so that evidence-based guidelines are available to cater to the special needs of Leprosy Afflicted Persons (LAPs).

More information

Type
Journal Article
Author
H U
Bharti D
Singhal S