Table 4.

Summary of Anesthesia Implications

Preoperative factors

Patients orthostatic hypotension with or without supine hypertension

Be aware of gastroparesis and aspiration risk

Be aware of blood volume status for the conduct of anesthesia

Be aware of slight anemia due to reduced erythropoiesis

Consider holding oral vasopressors to prevent drug interactions intraoperatively

Intraoperative factors

General versus regional anesthesia choice would be dependent on procedure type

Patients require adequate monitoring and constant vigilance

Hypothermia and hyperthermia are both risks with poor thermal regulation

Intubation may require rapid sequence with cricoid pressure

Patient positioning may have significant effects on vital signs

Nitroglycerine, prone positioning or reverse trendelenberg can be used for supine hypertension

Sudden blood volume changes may precipitate untoward blood pressure response (rapid infusions or rapid blood loss)

Pneumoperitoneum should be applied with extreme caution or avoided if possible

Vasopressors and Inotropes can have resistance or undue sensitivity (See Table 3.)

Abnormal electrolyte values affect responses to medications

Postoperative factors

Anticipate volume changes in the postoperative period and observe with a higher level of care

Orthostatic hypotension requires good blood volume and assistance with first ambulation

Abnormal electrolyte values affect responses to medications

Thermal regulation may be an issue in the recovery period

Ileus can be worsened by opiate use in the postoperative period

Restart home dysautonomia medications before discharge