Share on Facebook
Share on Twitter
Share via e-mail
Share on Google Bookmarks
Share on LiveJournal
Share on Newsvine
Share on Reddit
Share on Stumble Upon
Share on Digg

Disclaimer: The material presented in this site is intended for public educational purposes only. The author is not offering medical or legal advice. Accuracy of information is attempted but not guaranteed. Before undertaking any diet, or health improvement program, you should consult your physician. The author is in no way liable or responsible for any bodily harm, physical, mental or emotional state of any patient reacting to any of the content on this site. has not examined, reviewed or tested any product or service mentioned herein. We are not being paid to advertise or promote any product or service mentioned herein. The links are offered strictly as examples of resources available. The site assumes no responsibility or liability of any kind related to the content of external sites or the usage of any product or service referenced. Links to external sites were live at the time of creation of the link. does not create content for or manage external sites. The information can be changed or removed by the external site’s administrators at any time and they are responsible for the veracity of their information. Links are provided to support our data and supply additional resources. Please report broken links to is not a charitable foundation. It neither accepts nor distributes donations or funds of any kind.

Due to the rare nature of the disease, no specific technique has been recommended. The decision to employ either general anesthesia or regional block has to be made based on the type of surgery, involved anatomy, disease severity, patient preference, and comfort level of the participating anesthesiologist.1

Total intravenous anesthesia has been reported to be affective. Regional anesthesia could be advantageous by providing effective and deep analgesia without necessitating the use of muscle relaxants and inhalation agents.

Challenges to spinal block include difficulty locating anatomical landmarks, limitations to proper positioning, and a chance of painful spasms and rigidity in response to the needle insertion. Presence of an intrathecal pump may necessitate a fluoroscopic guided neuraxial procedure.

It is crucial that the anesthesiologist be informed of the medications and dosages you are taking. The various forms of anesthesia drugs, such as Versed and Propofol, often fall in the GABAergic category. When combined with your daily medications, anesthetics can cause a fatal overdose.

There are no contraindications to any anesthetic agents or procedures.  But due to the often high levels of muscle relaxers, patients should be monitored for hypotonia and the need for supportive ventilation.

Many anesthestic agents involve blockade of GABA receptors at various sites. Both inhalation agents and intravenous agents have the potential to cause hypotonia by causing GABA antagonism. They can increase the proportion of densitized neuromuscular receptors and can result in a non-competitive blockade and prolonged duration of action. The depth of neuromuscular blockade should be closely monitored and the muscle paralysis must be adequately reversed, keeping in mind there may be no correlation between depth of muscle paralysis and the hypotonia observed in several case reports.

There is no effect direct effect of SPS or its therapy on the neuromuscular junction, therefor should not affect the actions of nondepolarizing agents.

Patients may be on any combination of benzodiazepines, baclofen, gabapentin, vigabatrin, Venlafaxin, immunotherapy drugs, plasmapheresis, IVIG, or high-dose corticosteroids.

It is important to cover with steroid prophylaxis to supplement for the possible cortisone suppression. Diazepam and baclofen therapy should be continued during the perioperative period. Discontinuation could cause severe withdrawal reaction. The anesthetist should be aware of and prepared to respond to such a reaction. The patient may need supplemental steroid therapy if they are on long-term steroid medication.

Skeletal muscle relaxants should be avoided as they can potentiate hypotonia. Use of muscle relaxants needs to be monitored and small doses of short acting relaxant should be titrated.

Though there is little research, case reports document resistance to succinyl choline.

If the patient has kyphosis, hyperlordosis, or contracture, care must be taken with positioning. The patient should be positioned with the appropriate aids or pillows.

The patients have a startle reaction to voluntary movement, emotional upset, or unexpected auditory, tactile, or somatic stimuli. Especially when prone, they should be well supported for rigidity and sudden spasms.

In addition to routine monitoring of blood pressure, oxygen saturation, ECG and endtidal CO2, the anesthetist should monitor for neuromuscular paralysis. There is potential for respiratory insufficiency due to muscular rigidity.

Bispectral index should be kept between 40 and 60, indicating the depth of anesthesia.

Although no association with malignant hyperthermia is suspected, it allows you to differentiate the possible complications including baclofen withdrawal and nerolept malignant syndrome.

1. Anesthesia recommendations for patients suffering from stiff-man synrome. (Full file) Orphan You should print this off and take it with you if you have surgery. It gives specific instructions. Link to article

2. Sidransky MA, Tran NV, Kaye AD. Anesthesia considerations in stiff-person syndrome. Middle East.J. Of Anesthesiol;2013 Jun; 22(2):217-21.  (Full File)

Link to article

3 Bouw J, Leendertse K, Tijssen MA, Dzoljic M. Stiff person syndrome and anesthesia: case report. Anesth Analg. 2003 Aug;97(2):486-7. Link to article

This case report describes the successful perioperative management of a patient with a rare and disabling neurologic disorder, the stiff person syndrome. The patient had a delayed emergence despite apparent full reversal of neuromuscular blockade. We suggest an interaction between the GABAergic effects of baclofen and volatile anesthetics as a possible cause.

4 Johnson JO, Miller, KA. Anesthetic Implications in Stiff-Person Syndrome. Anesthesia & Analgesia. March 1995 - Volume 80 - Issue 3 - pp 612-613. (Full File)

Link to article

5. Neubert L, Green P, Green MS. Anesthetic care of stiff person syndrome in the outpatient setting. (Full File)

Link to article

6. Qin X, Wang Dx, Wu XM. Anesthetic management of a patient with stiff-person syndrome and thymoma: a case report. Chin Med J (Engl). 2006 Jun 5;119(11):963-5.

(Full File)     Link to article

7. Yagana O, Özyilmaza K, Özmadena A, Sayinb O, Hanci V. Anesthesia in a patient with stiff person syndrome. DOI: 10.1016/j.bjane.2013.02.004.     Link to article

8. Shanthanna H. Stiff Man Syndrome and Anaesthetic Considerations: Successful Management Using Combined Spinal Epidural Anaesthesia. J Anaesthesiol Clin Pharmacol. 2010 Oct-Dec; 26(4): 547–548. (Full File)

Link to article

9. Toscano FV, Vick AK, Shay HH, Delphin ES. Total intravenous anesthesia (TIVA) for stiff-person syndrome. Open Journal of Anesthesiology, 2012. Published Online September 2012 (

(Full File)     Link to article

10. Johnson JO, Miller KA. Anesthetic implications in stiff-person syndrome. Anesth Analg 1995;80:612-3. (Full File)

Link to article

11. Gros AJ Jr, Thomas LC, McKinley KL, Van Gerpen JA. Prevention of an acute severe exacerbation of Stiff-person syndrome during surgery. Anesthesiology. 2006 Apr;104(4):885-6.  Link to article


Living with SPS  Self Care   Grooming   Dressing   Bedroom Safety   Housebound/Bedridden   

Kitchen,Cooking & Groceries  Home Care  Hiring a Service   In-Home Care   Exercise   Mobility   Driving

Managing Medications  SPS & Pregnancy   Organizing Information   Financial Aid   Legal Aid   Mental Health

Anxiety & Depression   Suicide Prevention   Relationship Health   Risk of Abuse   Venting   Caregiving

Emergency Care   Anesthesia