Recommendations For Persons With CFS Or Fibromyalgia Who
Are Anticipating Surgery
CFS is a disorder characterized by severe
debilitating fatigue, recurrent flu-like symptoms, and
neurocognitive symptoms such as difficulties with
memory, concentration, comprehension, recall,
calculation and expression. A sleep disorder is not
uncommon. All of these symptoms are aggravated by even
minimal physical exertion or emotional stress, and
relapses may occur spontaneously. Although mild
immunological abnormalities (T-cell activation, low
natural killer cell function, dysglobulinemias, and
autoantibodies) are common in CFS, subjects are not
immunocompromised and are no more susceptible to
opportunistic infections than the general population.
The disorder is not thought to be infectious.
with CFS frequently re-activate latent herpes group
viruses, which may produce a mild, subclinical hepatitis
with slight elevations of the transaminases. Thus,
hepatotoxic anesthetic agents should be avoided because
they could potentiate the liver problem or even provoke
Intracellular magnesium and potassium depletion has been
reported in CFS. For this reason, serum magnesium and
potassium levels should be checked pre-operatively and
these minerals replenished if borderline or low.
Intracellular magnesium or potassium depletion could
potentially lead to cardiac arrhythmias under
to 97% of persons with CFS demonstrate vasovagal syncope
(neurally mediated hypotension) on tilt table testing,
and a majority of these can be shown to have low plasma
volumes,low RBC mass, and venous pooling. Syncope may be
precipitated by cathecholamines (epinephrine),
sympathomimetics (isoproterenol), and vasodilators
(nitric oxide, nitroglycerin, a-blockers, and
hypotensive agents). Care should be taken to hydrate
patients prior to surgery and to avoid drugs that
stimulate neurogenic syncope or lower blood pressure.
Allergic reactions are seen more commonly in persons
with CFS than the general population. for this reason,
histamine-releasing anesthetic agents (such as
pentothal) and muscle relaxants (curare, Tracrium, and
Mevacurium) are best avoided if possible. Propofol,
midazolam, and fentanyl are generally well-tolerated.
Most CFS patients are also extremely sensitive to
sedative medications -- including benzodiazepines,
antihistamines, and psychotropics -- which should be
used sparingly and in small doses until the patient's
response can be assessed.
Finally, HPGA Axis Suppression is almost universally
present in persons with CFS, but rarely suppresses
cortisol production enough to be problematic. Seriously
ill patients might be screened, however, with a 24 hour
urine free cortisol level (spot or random specimens are
usually normal) or Cortrosyn stimulation test, and
provided cortisol supplementation if warranted.