Tag: anesthesia

Perioperative outcomes in patients with myalgic encephalomyelitis/chronic fatigue syndrome undergoing general anesthesia: a retrospective matched-pair study

Abstract:

Background: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a chronic multisystem disease characterized by profound fatigue, post-exertional malaise, cognitive impairment, and autonomic dysfunction. Despite features with potential relevance for anesthesia and perioperative care, empirical data on perioperative outcomes in patients with ME/CFS remains limited. We therefore performed a retrospective matched-pair analysis to generate clinical data on perioperative responses and identify areas for future research.

Methods: We conducted a retrospective matched-pair analysis at a single tertiary center. All patients with ME/CFS undergoing general anesthesia from 2015 to 2026 were identified using ICD-10-GM codes with additional manual verification and matched 1:1 to controls for comparison. Patients with confounding diagnoses or American Society of Anesthesiologists physical status above III were excluded. The analysis focused on intraoperative hemodynamic parameters, including baseline, post-induction, median, and lowest recorded systolic blood pressure and heart rate, as well as early postoperative outcomes in the post-anesthesia care unit (PACU), including maximum pain scores and requirement for rescue analgesia.

Results: Out of 189 individuals identified through ICD-10 codes, 15 matched pairs were included after application of exclusion criteria. Patients with ME/CFS exhibited lower minimum intraoperative systolic blood pressure (90.0 [82.5-95.0] vs. 100.0 [90.0-110.0] mmHg, p = 0.044) and lower minimum heart rate (50.0 [40.0-57.5] vs. 60.0 [50.0-65.0] bpm, p = 0.012). Vasopressor use and fluid administration did not differ, and no episodes of severe hypotension or perioperative adverse events were observed. Postoperative pain was higher in ME/CFS, with higher maximum pain scores (NRS 5.0 [4.0-6.0] vs. 1.0 [0.0-4.0], p = 0.008) and more frequent opioid rescue analgesia (80% vs. 33%, p = 0.039). Postoperative nausea or vomiting, oxygen supplementation, and PACU length of stay were similar between groups.

Conclusions: In this small exploratory cohort, general anesthesia was not associated with clinically relevant hemodynamic instability in patients with ME/CFS. Postoperative pain scores and opioid rescue requirements were higher in the ME/CFS group. Post-exertional malaise, a key disease feature with potentially delayed onset and significant impact, was not captured and remains an important target for future research. These findings should be considered hypothesis-generating and support prospective studies evaluating perioperative management and patient-relevant outcomes in ME/CFS.

Source: Steinkirchner FM, Kaufmann CK, Kraus RF, Käss M, Schieffer E, Graf BM, Lassen C, Kimmerling V, Dejaco A. Perioperative outcomes in patients with myalgic encephalomyelitis/chronic fatigue syndrome undergoing general anesthesia: a retrospective matched-pair study. BMC Anesthesiol. 2026 Jul 16;26(1):426. doi: 10.1186/s12871-026-04102-5. PMID: 42464211. https://link.springer.com/article/10.1186/s12871-026-04102-5 (Full text available as PDF file)

Anaesthesia for patients with idiopathic environmental intolerance and chronic fatigue syndrome

Abstract:

BACKGROUND: Idiopathic environmental intolerance syndrome (IEI), formerly known as multiple chemical sensitivity syndrome (MCSS), andchronic 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.

 

Source: Fisher MM, Rose M. Anaesthesia for patients with idiopathic environmental intolerance and chronic fatigue syndrome. Br J Anaesth. 2008 Oct;101(4):486-91. doi: 10.1093/bja/aen242. http://bja.oxfordjournals.org/content/101/4/486.long (Full article)