Anesthetic concerns for Lyme disease patients

Doctors gives anesthetic medication to patient with Lyme disease.

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.”

  1. Smit T. Lyme Disease and Anesthesia Considerations. AANA J. Dec 2017;85(6):427-430.

5 Replies to "Anesthetic concerns for Lyme disease patients"

  • Sara Pickart
    04/01/2024 (8:28 pm)

    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?

  • Angela Hilsenbeck
    02/01/2024 (1:43 pm)

    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

    • Dr. Daniel Cameron
      02/04/2024 (8:22 am)

      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.

  • Pamela Gani
    10/21/2022 (1:00 pm)

    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.

  • Carol Rosskopf
    10/05/2022 (8:52 pm)

    I’m praying for cure for Lyme disease.
    Twenty eight days of an antibiotic is not enough!

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