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Leprosy and anaesthesia : Peri-operative concerns in patients with Hansen's disease
Abstract
Leprosy is a chronic granulomatous disease caused by Mycobacterium leprae, with wide spread systemic
manifestations. Its prevalence is high in the developing world and it is, in fact, a leading cause of severe
neuropathy in the developing world. Hence, the likelihood of encountering leprosy patients in daily
anesthesia practice is quite high. Despite this, literature pertaining to anaesthesia in leprosy patients is quite
meagre. This article attempts to explore the available literature on leprosy relevant to anaesthesiologists, in
order to substantiate recommendations for administering safe and effective anaesthesia in leprosy patients.
A thorough pre-operative evaluation is required as leprosy affects almost all organ systems. Intra-operatively,
induction and extubation must be smooth and stress response to airway management must be minimised.
Nasal manipulations are preferably avoided. Before regional anaesthesia, proper documentation of nerves
involved by the disease must be noted and blind nerve blocks must be abandoned. All pressure points and
bony prominences must be padded. Special precaution must be taken in preventing hypothermia,
neuropathy and myopathy. Drug interactions with anaesthetic agents should also be kept in mind. Social
rehabilitation and psychological support during the entire perioperative period for these patients goes a long
way in ensuring a successful operative outcome. As there are very few publications on use of different
anaesthesia methods in these cases, emphasis should be to document and analyse the experiences so that
evidence-based guidelines are available to cater to the special needs of Leprosy Afflicted Persons (LAPs).
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Type
Journal Article