Lyme Disease and Anesthesia Considerations

Lyme disease anesthesia considerations are important for patients undergoing surgical procedures. Undiagnosed Lyme disease, neurologic involvement, and cardiac complications can affect perioperative management and anesthetic choices.

In her article “Lyme Disease and Anesthesia Considerations,” Smit discusses several issues anesthetic practitioners should consider when caring for patients with Lyme disease.

Disease Awareness

Some surgical patients may have Lyme disease that has not yet been diagnosed.

“Infected patients in whom the diagnosis has not yet been made or has been missed may present for invasive investigations such as biopsies or arthroscopies or for larger surgical interventions such as joint replacement or pacemaker insertion,” wrote Smit.

A careful medical history and physical examination may help identify Lyme disease symptoms before surgery.

Assessment of Target-Organ Damage

Patients with Lyme disease may require additional evaluation depending on organ involvement.

Some patients may develop Lyme carditis, which can affect cardiac conduction and may require monitoring during anesthesia.

Others may present with neurologic Lyme disease. The author notes that neurologic manifestations may include:

• Headaches
• Cranial nerve palsies, particularly bilateral facial nerve involvement
• Meningitis

Borrelia encephalopathy, though uncommon, has also been described. This condition may involve disturbances in mood, personality, sleep, memory, and concentration.

“Anesthetic practitioners should be aware of the clinical presentations of the disease as well as have a clear understanding of the anesthetic implications of the disease.”

Anesthesia-Specific Concerns

The author also raised several anesthesia-specific concerns.

Central neuraxial blockade may introduce infectious agents into the central nervous system in certain situations.

General anesthesia may also affect immune function. According to Smit, “A strong body of evidence has emerged demonstrating that volatile anesthetic agents adversely affect the function of neutrophils, macrophages, and natural killer cells.”

This effect has not been described with propofol.

“It may therefore be prudent to avoid the use of volatile anesthesia in patients with active disease and to rather make use of propofol-based total intravenous anesthesia.”

Antibiotic Management During Surgery

Patients undergoing prolonged treatment for Lyme disease should generally continue their antibiotic therapy.

If oral therapy cannot be administered — for example if the patient is ventilated or NPO — intravenous antibiotics may be used to maintain appropriate treatment coverage.

Perioperative Monitoring

Patients with cardiac or neurologic complications of Lyme disease may require closer perioperative monitoring.

The author concluded that anesthetic choices should be carefully considered.

“The impact that the choice of anesthetic technique may have on disease progression should be considered and discussed with the patient.”