Best practices for hospitals

Anesthesia
It is important for patients to meet with their anesthesiologists in advance to discuss special considerations for anesthesia. Many patients with ME have mast cell activation disorder or are otherwise sensitive to certain classes of drugs currently used in anesthesia. Anesthesiologists may need to create a special protocols, for example, avoiding histamine-releasing and muscle-relaxing drugs.

In addition, patients with ME may have undiagnosed or subclinical structural cervical issues such as craniocervical instability or cervical spinal stenosis. It may be important for some patients, if at all possible, to have their head and neck kept in a neutral position during surgery to help limit the risk of exacerbation or damage. This is especially important for patients with hypermobility, Ehlers-Danlos syndrome or Postural orthostatic tachycardia syndrome.

Handouts

 * Advice for PWCs Anticipating Anesthesia or Surgery (Hunter Hopkins Center)

Recovery
Patients with ME will benefit from environments where they can sleep and have minimal disruption. Patients can benefit from:


 * Sound-tight rooms (as opposed to open curtains) and rooms that can be made completely dark
 * Placement on a quiet ward
 * Chemical/fragrant-free nursing support


 * Minimal nighttime disruptions (e.g., middle of the night blood pressure monitoring) if possible, depending on their medical condition
 * Extra IV saline, particularly for patients who are diagnosed with POTS, have low blood volume, and/or have prior experience with saline.

It may take patients longer to recover and this should be planned for in advance. For example, if a procedure requires a one night stay for recovery, a patient with ME might need two.