In patients with multiple sclerosis, which factor is most associated with exacerbation during surgery?

In patients with multiple sclerosis, intraoperative hyperthermia is particularly associated with exacerbation during surgery because elevated body temperature can provoke clinical worsening of the disease. Multiple sclerosis is characterized by the demyelination of nerve fibers, and many patients experience symptom exacerbation when their body temperature rises. This phenomenon is often referred to as Uhthoff's phenomenon, where heat sensitivity leads to a temporary increase in neurological symptoms.

Intraoperative hyperthermia may occur due to factors such as anesthesia-induced alterations in thermoregulation or prolonged surgical procedures. As a result, managing body temperature during surgery is crucial for minimizing the risk of exacerbation and ensuring the best possible outcomes for patients with multiple sclerosis.

In contrast, ketorolac, while it is a nonsteroidal anti-inflammatory drug used for analgesia, does not have the same direct link to exacerbating multiple sclerosis symptoms during surgery. Similarly, neuromuscular blockade and its reversal are standard practices in surgical procedures and do not inherently increase the risk of exacerbation in individuals with multiple sclerosis.