title: Anesthetic management of a patient with multiple sclerosis - case report.
abstract: OBJECTIVE
  Multiple sclerosis is a demyelinating disease of the brain and spinal cord, characterized by muscle weakness, cognitive dysfunction, memory loss, and personality disorders. Factors that promote disease exacerbation are stress, physical trauma, infection, surgery, and hyperthermia. The objective is to describe the anesthetic management of a case referred to urological surgery.
  
  
  METHODS
  A female patient, 44 years of age, with multiple sclerosis, diagnosed with nephrolithiasis, referred for endoscopic ureterolythotripsy. Balanced general anesthesia was chosen, with midazolam, propofol and remifentanil target-controlled infusion; sevoflurane via laryngeal mask airway; and spontaneous ventilation. Because the patient had respiratory difficulty presenting with chest wall rigidity, it was decided to discontinue the infusion of remifentanil. There was no other complication or exacerbation of disease postoperatively.
  
  
  CONCLUSIONS
  The use of neuromuscular blockers (depolarizing and non-depolarizing) is a problem in these patients. As there was no need for muscle relaxation in this case, muscle relaxants were omitted. We conclude that the combination of propofol and sevoflurane was satisfactory, not resulting in hemodynamic instability or disease exacerbation.
authors.affiliation: Centro de Ensino e Treinamento em Anestesiologia (CET-SBA), Clinica de Anestesiologia de Ribeirão Preto (CARP), Ribeirão Preto, SP, Brazil.
authors.forename: Eduardo Barbin
authors.initials: EB
authors.lastname: Zuccolotto
authors.affiliation: Centro de Ensino e Treinamento em Anestesiologia (CET-SBA), Clinica de Anestesiologia de Ribeirão Preto (CARP), Ribeirão Preto, SP, Brazil.
authors.forename: Guilherme Coelho Machado
authors.initials: GC
authors.lastname: Nunes
authors.affiliation: Centro de Ensino e Treinamento em Anestesiologia (CET-SBA), Clinica de Anestesiologia de Ribeirão Preto (CARP), Ribeirão Preto, SP, Brazil.
authors.forename: Rafael Soares Lopes
authors.initials: RS
authors.lastname: Nogueira
authors.affiliation: Centro de Ensino e Treinamento em Anestesiologia (CET-SBA), Clinica de Anestesiologia de Ribeirão Preto (CARP), Ribeirão Preto, SP, Brazil. Electronic address: md.eugenio@gmail.com.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Pagnussatt Neto
authors.affiliation: Centro de Ensino e Treinamento em Anestesiologia (CET-SBA), Clinica de Anestesiologia de Ribeirão Preto (CARP), Ribeirão Preto, SP, Brazil.
authors.forename: José Roberto
authors.initials: JR
authors.lastname: Nociti
mesh_terms: D000328:Adult; D000768:Anesthesia, General / Q000379:methods*; D005260:Female; D006801:Humans; D009103:Multiple Sclerosis / Q000150:complications* / Q000601:surgery; D053040:Nephrolithiasis / Q000150:complications* / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*
keywords: Cirurgia urológica; Esclerose múltipla; Multiple sclerosis; Propofol; Remifentanil; Sevoflurane; Sevoflurano; Urologic surgery