Anaesthesia implications in patients with Tuberculosis of Central Nervous System

Tuberculosis has resurged and remained a major worldwide health problem. Approximately 5–10% of all patients with tuberculosis have CNS involvement. CNS tuberculosis usually results from haematogenous spread. CNS tuberculosis manifests itself primarily as tuberculous meningitis (TBM) and less commonly as tubercular encephalitis, intracranial tuberculoma, or a tuberculous brain abscess (3).

PURPOSE OF TRIAL:

Patients with CNS tuberculosis may also have several general or systemic problems like malnourishment, respiratory compromise due to either tuberculosis or secondary to unconsciousness, electrolyte abnormalities etc. All these pose additional concerns while providing anaesthesia when, such patients present for surgery. Therefore, the present study is undertaken to evaluate anaesthesia concerns and their management during surgery in patients with CNS tuberculosis.

METHODOLOGY:

After IEC-HR Permission, patients provisionally diagnosed or confirmed as CNS tuberculosis satisfying all inclusion and exclusion criteria will be included into the study. All patients/patients relativeswill be explained about the study and a written valid informed consent for their willingness to participate in the study will be taken.

All the basic information about the patient and preoperative concerns will be noted from the patient’s history and case sheets. The type and severity of CNS tuberculosis will be noted. Preoperative evaluation will be carried out and all general and/or systemic abnormalities will be noted. Patient will be managed intra-operatively as per concerned qualified anesthesiologist’s discretion. Any alterations in anaesthesia protocol- in technique, drug choices or drug dosages will be noted along with the reasons. Any problems faced during the entire perioperative period (till 24 hours post-anaesthesia) will be noted in the case record form along with the management. This a present observational study.

For the current study following parameters will be noted:

1.    Type of Tuberculosis

2.    Medication history

3.    General examination findings

4.    CT scan findings

5.    Type of anaesthesia given

6.    Anaesthesia Implications:

·       Related with CNS Tuberculosis

·  Airway obstruction

·  Increased intracranial pressure

·  Active infection

·  Fever

·  Leukocytosis

·  Low serum proteins

·       Related with complications of disease

·  Pulmonary aspiration

·  Electrolyte imbalance

·  Arrhythmia

·  Bed sores

·       Related with concomitant disease

·  HIV

·       Related with therapy

·  Liver dysfunction

7.    Anaesthesia alterations

8.    Anaesthesia problems

9.    Perioperative complications

DATA ANALYSIS:

Statistical analysis will be performed using commercially available statistical software (SPSS 19.0; SPSS, Inc.). Chi-square tests will be used for assessing the association between study variables and outcome. Multivariate analysis with binary logistic regression analysis will be performed to look for the predictors of long-term outcome; p < 0.05 will be considered to be significant.

WORK DONE SO FAR:

Many studies have been done in past, which have found the complications related with CNS tuberculosis and its treatment. Some studies have been done about anaesthesia implications in tuberculosis. But,the anaesthesia concerns in CNS tuberculosis patients and their management has not been studied much, which is being done in our study.