Anesthetic concerns for Lyme disease patients

Some Lyme disease patients require anesthetic evaluation before a procedure. Tammy Smit, MSNA, CRNA discussed a helpful approach for patients who required anesthesia for a surgical procedure in the American Association of Nurse Anesthesiology (AANA) journal. [1]

In her article “Lyme Disease and Anesthesia Considerations,” Smit discusses three approaches:

Disease awareness

Some patients may have Lyme disease that has not 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 good history and physical examination should help.

Assessment of Target-Organ Damage

Some patients might need consultations. Lyme patients may present with Lyme carditis. Others can present with neurologic Lyme disease. “This leads to a wide range of clinical presentations, the most common of which are headaches, cranial nerve palsies (in particular, bilateral upper and lower seventh cranial nerves), and meningitis,” wrote the author. “Borrelia encephalopathy, which rarely occurs, has also been described and is associated with 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 raised potential anesthesia-specific concerns. Central neuraxial blockade may introduce infective agents into the central nervous system. “General anesthesia may suppress the immune system,” wrote the author. “A strong body of evidence has emerged demonstrating that volatile anesthetic agents adversely affect the function of neutrophils, macrophages, and natural killer cells…. the 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.”

The author advised that oral antibiotics for Lyme disease be continued if a patient undergoes prolonged therapy. If they are unable to take oral therapy (i.e. being ventilated or NPO), they should receive intravenous antibiotics to cover the dosage.

Lastly, patients with cardiac or neurologic complication of Lyme may need closer perioperative monitoring.

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