Perioperative management and preoperative assessment of neurologic diseases

Frequently, the practicing neurologist is called to evaluate and render an expert opinion on challenging aspects during the peri- and postoperative care of patients with neurologic diseases. How should a patient who has Parkinson's disease be treated during the perioperative period? Can anticoagulation be used for the prevention of deep vein thrombosis after a neurosurgical procedure or an intracerebral catastrophe? How should patients with neuromuscular diseases be assessed and managed perioperatively? What is the neurologist to do when confronted with the problem of the “difficult to extubate” patient? How should the neurologist assess and treat the acute confusional state in the postoperative neurologic patient? What should the neurologist know about the pulmonary evaluation of the neurologic patient? What abnormal involuntary movements may occur in the postoperative and intensive care setting and how should they be treated? What ethical issues may confront the neurologist in treating patients with major neurologic illnesses? These are some of the questions I am hoping we can answer with this issue of the Neurologic Clinics. We formulated the topic of perioperative neurology in hopes of encompassing both the presurgical assessment and perioperative care of the neurologic patient.

We begin with an overview of the most common disorders that practicing neurologists may be requested to evaluate, followed by a more in-depth review of perioperative issues confronted by the treating physician. We end with the study of the most complex ethical questions faced by the neurologist when confronted with patients with major neurologic illnesses. The goal is to provide readers with useful clinical information in state-of-the-art benchmark papers from which they will be able to further their knowledge. I am indebted to the authors, all recognized leaders in their respective areas of interest, who took time from their extremely busy medical or academic practices to share their experiences and participate in this project. I would also like to thank my wife Lucy and my children Kassandra, Jessica, and Nicholas for their love and steadfast support.