Lyme Disease and Anesthesia: Key Considerations Before Surgery
Undiagnosed Lyme disease can be missed
Cardiac and neurologic involvement matters
Anesthesia choices may affect outcomes
Lyme disease and anesthesia require careful evaluation before surgery. Patients may have undiagnosed infection or organ involvement that can influence anesthetic decisions and perioperative care.
Disease Awareness
Some patients presenting for surgery may have undiagnosed Lyme disease.
These individuals may undergo:
- Biopsies or arthroscopy
- Joint replacement
- Cardiac procedures such as pacemaker insertion
A careful history and physical exam are essential to identify possible Lyme disease.
For symptom recognition, see Lyme disease symptoms guide.
Assessment of Target-Organ Involvement
Lyme disease may affect multiple systems relevant to anesthesia.
Patients may present with:
- Lyme carditis (conduction abnormalities)
- Neurologic Lyme disease
Neurologic manifestations may include:
- Headache
- Cranial nerve palsies (including bilateral facial palsy)
- Meningitis
Rarely, Lyme encephalopathy may occur, affecting:
- Mood and personality
- Sleep
- Memory and concentration
“Anesthetic practitioners should be aware of the clinical presentations of the disease as well as the anesthetic implications,” the author notes.
Anesthesia-Specific Concerns
Several anesthesia-related considerations may influence care:
- Central neuraxial anesthesia may introduce infection into the central nervous system
- General anesthesia may affect immune function
Evidence suggests:
- Volatile anesthetics may impair neutrophil, macrophage, and natural killer cell function
- This effect has not been clearly described with propofol
“It may be prudent to avoid volatile anesthesia in active disease and consider propofol-based total intravenous anesthesia (TIVA),” the author suggests.
Anesthetic decisions should be individualized based on clinical context.
Antibiotic Management
Patients receiving Lyme disease treatment are generally advised to continue antibiotics.
If oral therapy is not possible:
- Intravenous antibiotics should be used
This ensures continuity of treatment during the perioperative period.
Perioperative Monitoring
Patients with cardiac or neurologic Lyme disease may require:
- Closer intraoperative monitoring
- Postoperative observation
Monitoring needs depend on symptom severity and organ involvement.
Clinical Perspective
The choice of anesthetic technique may influence disease course and recovery.
This should be discussed with the patient as part of preoperative planning.
Clinical Takeaway
Lyme disease and anesthesia require thoughtful, individualized planning.
Undiagnosed infection, cardiac involvement, and neurologic symptoms may affect surgical management.
Careful evaluation and appropriate anesthetic selection can help reduce risk and improve outcomes.
Related Reading
- Patient experiences with healthcare
- Herxheimer reaction in Lyme disease
- Autonomic dysfunction in Lyme disease
Reference
- Smit T. AANA Journal. 2017.
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
I’m praying for cure for Lyme disease.
Twenty eight days of an antibiotic is not enough!
Ironically I had a surgery, woke up in the middle of it & FELT EVERYTHING from the moment I awakened during the procedure to the memory of the pain for months later. I remember them administering benedryl & suddenly I was ready to jump off the table. I’m not sure if this is relatable or not, but I figured I’d add it in in case someone else can relate.
I’m going to have a total knee done in march after my disability hearing. I’m scared and needed some advice as I do have Lyme disease and it was diagnosed in 2022 after suffering for over 10 years. I have the neurological Borrelia Lyme disease which is very rare. I have encephalopathy with mood, sleep, memory and concentration issues. Please give me any advice you might have to help and I am so thankful for the advice as I am in the dark here with this disease. Thank you, Angela Hilsenbeck
I often have patients with chronic neurologic Lyme disease first described in a 1990 New England Journal of Medicine article by Drs. Logigian, Kaplan and Steere called Chronic Neurologic Lyme.
I’m 18 weeks pregnant with twins and will most likely have to deliver via C-Section. I have not been diagnosed, but for years have exhibited neurological, cardiac complications and Herxheimer reactions that a previous LLMD correlates with Lyme. A good friend with similar symptoms but far more advanced Lyme passed away from Lyme Carditis in 2020
I moved to a different state and haven’t been able to afford treatment, Currently do not have a Lyme doctor and Im concerned about anesthesia during the C-section. I’ve already been in the ER multiple times during this pregnancy for heart palpitations, uncontrollable rigors and weakness. I feel like I herx so easily and am a bit terrified to be honest. Anyone have any advice?