14 September 2008
Journal: Br J Anaesth. 2008 Oct;101(4):486-91.
Authors: Fisher MM, Rose M.
Affiliation: Royal North Shore Hospital of Sydney, St Leonards, NSW
2065, Australia.
NLM Citation: PMID: 18782886
BACKGROUND: Idiopathic environmental intolerance syndrome (IEI),
formerly known as multiple chemical sensitivity syndrome (MCSS), and
chronic fatigue syndrome (CFS) are controversial diseases and there
is little information in the literature regarding the appropriate
conduct of anaesthesia in such patients.
METHODS: We studied 27 patients referred to our anaesthetic allergy
clinic with IEI and CFS and performed literature and web searches on
anaesthesia in these disorders.
RESULTS: The patients had a significant incidence of adverse events
related to anaesthesia which were not allergic in nature. The adverse
effects usually occurred postoperatively and were self limiting.
Patients with IEI and CFS are not at risk of anaphylaxis and there is
no scientific evidence that any drug or technique is excessively
hazardous. Neither our patients nor the review of the scientific
literature supported available web-based recommendations for the
anaesthetic management of patients with IEL and CFS.
CONCLUSIONS: We suggest that the anaesthetist may be best to use the
technique they would use if the patient did not have CFS or IEI but
avoid drugs to which there is a history of adverse response.
Anaesthesia is likely to be associated with adverse effects in these
patients but the effects are not likely to be severe. A series of
recommendations for the safe and harmonious conduct of anaesthesia in
patients with CFS and IEI are provided.