Letters
Volume 199 - Issue 2

Restless legs syndrome and day procedures

Author:  Ivan Cher

Med J Aust 2013; 199 (2): 100-101. || doi: 10.5694/mja13.10081
Published online: 22 July 2013
To the Editor: This letter encourages timely preoperative recognition of restless legs syndrome (RLS), for patient wellbeing, as well as for practical management of incidental procedures. RLS is a neurological disorder found in many older patients of either sex and in those with a variety of conditions including iron deficiency, pregnancy, uraemia, diabetes and rheumatoid arthritis. It may also affect patients with other neurological disorders ...
Download PDF (108 KB)
Share: Share on Blue Sky Share on Facebook Share on LinkedIn Share by email

To the Editor: This letter encourages timely preoperative recognition of restless legs syndrome (RLS), for patient wellbeing, as well as for practical management of incidental procedures. RLS is a neurological disorder found in many older patients of either sex and in those with a variety of conditions including iron deficiency, pregnancy, uraemia, diabetes and rheumatoid arthritis. It may also affect patients with other neurological disorders such as peripheral neuropathy.1

Affected persons have spontaneous, recurring, unpleasant leg paraesthesia, which they may find difficult to describe. Patients know that these discomforts are about to climax into sudden involuntary movement of the limb or limbs. RLS occurs mainly in the late afternoon and evening, especially when patients are seated or supine. Sleep may be disturbed. The anticipated movement can be overcome by voluntary activation of the limb or limbs, by bearing weight or by pacing.2 RLS is believed to arise from abnormalities in brain neurotransmitters that regulate automatic movements.

Dopamine receptor agonist medications can suppress the attacks but not cure them.1-4 In patients whose drug therapy is already effective, perioperative stress may bring on RLS, as will dopamine antagonists.1,3 Where RLS is suspected or actual, medications that may exacerbate RLS symptoms should not be used, particularly in day surgery.1,3,4 The following medications should be avoided, whether as premedications, intra-procedural drugs or sedatives:

Surgeons and others who perform procedures (including ophthalmologists, dentists and endoscopists) should ask screening questions before procedures and check for the occurrence of RLS and related sleep disorder. Informed consent should be obtained and pre- and perioperative therapy established. An anaesthetist should be in attendance for the procedure when treating a patient with RLS. All assistants and nursing staff should be informed about this patient’s RLS, and warned that pinning down a patient’s jerking legs may cause reciprocal jerks of the upper torso.

Drugs that relieve RLS should be made available in the procedural theatre or dental practice, eg, intravenous physostigmine 1–2 mg, opioids, oral pramipexole and ropinirole.3-5

(Coincidentally, from February 2013, RLS has been renamed Willis–Ekbom Disease, after the Restless Legs Syndrome Foundation adopted this new title.)

Author

  • Ivan Cher1
  • 1. Melbourne, VIC.

Correspondence: ivan@cher.net.au

Competing interests

No relevant disclosures.

References

View this article on Wiley Online Library