Multiple sclerosis: exacerbation

According to Miller, “It has been speculated that general anesthesia and surgery may increase the risk for aggravation of MS. At present, there is no general consensus on this matter, and patients should therefore be informed of the potential for aggravated symptoms in the postoperative period” (p 1172), and “There has been no documented association with the type of anesthetic or particular anesthetic agents and exacerbation of disease” (p 1031-21). According to Stoelting’s Co-Existing Disease, the suggested reason that spinals (and not epidurals) have been implicated in exacerbation is that CNS demyelination may render the spinal cord overly sensitive to local anesthetics – epidural anesthestics result in lower concentrations of LA in the white matter.

One element of anesthesia care which may be extremely important is temperature management – increases as little as 1 C may lead to disease exacerbation.

Multiple Sclerosis Anesthetic Considerations / Concerns

  • Possibility of exacerbation should be mentioned, although this is speculative at best
  • No anesthetic technique has been shown to be superior to another, although spinals may exacerbate symptoms and are not recommended
  • Impaired autonomic function
  • High sensitivity to physical and emotional stress
  • May be susceptible to hyperkalemia following SCh
  • Avoid hyperthermia
  • Have a low threshold for ICU admission post-operatively

Keyword history



  1. Miller’s Anesthesia, 7th edition, Churchill Livingstone: p 1031-2, 1172. 2009 (ISBN 9780443069598)
  2. Hines RL and Marschall, KE. Stoelting’s Anesthesia and Co-Existing Disease, 5th Ed, Saunders: Chapter 10A. 2008 (ISBN 1416039988)