2026 FSA Podium and Poster Abstracts

Introduction/Background: Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) is a rare immune-mediated neuropathy associated with progressive motor and sensory dysfunction affecting over 20 per 100,000 people in the U.S. Perioperative management is challenging due to risks of respiratory compromise, autonomic instability, and potential neurologic worsening following anesthesia. Despite these risks, no standardized guidelines exist for perioperative anesthetic planning in CIDP. This study reviews and synthesizes anesthetic techniques and associated outcomes, aiming to inform clinical decision-making regarding anesthetic management.

Methods: A systematic search of PubMed, Embase, and Web of Science was conducted through February 2026. Eligible studies included case reports or series describing anesthetic management in patients with confirmed CIDP undergoing surgery. Inclusion criteria required the evaluation of anesthetic modality and post-operative neurologic outcomes, focusing on qualitative and quantitative data. Data extracted included anesthetic modality, use of neuromuscular blocking agents (NMBA), intraoperative considerations, and postoperative neurologic outcomes. Two reviewers independently screened studies and extracted data.

Results: Of 15 studies identified, 14 met the inclusion criteria, comprising 30 patients. Twenty-four patients received a single anesthetic modality, most commonly general anesthesia (GA) (n=19). General Anesthesia was defined as receiving inhalational anesthesia (n=16) or total intravenous anesthesia (TIVA) (n=3). Six patients underwent two modalities; typically, regional anesthesia combined with general anesthesia to reduce NMBA exposure. Among the single-modality group, three patients experienced postoperative worsening of CIDP symptoms, including one death. All three had received non-depolarizing NMBAs (atracurium or rocuronium) alongside inhalation anesthesia, with doses ranging from 60–150 mg. In contrast, cases utilizing adjunct regional anesthesia with TIVA, such as femoral, abdominal wall, or neuraxial blocks, reported stable respiratory mechanics, successful surgical conditions, and no neurologic deterioration, particularly when block level remained below T12. The cumulative incidence of postoperative adverse effects (AEs) was 10.0%.

Discussion/Conclusion: Our review highlights that perioperative anesthetic management in CIDP requires individualized planning due to variability in disease severity and responses to anesthetic agents. Postoperative neurologic worsening occurred primarily in patients receiving inhalational anesthesia with non-depolarizing neuromuscular blocking agents, suggesting heightened vulnerability in those with long-standing or clinically active disease. In contrast, the use of TIVA, particularly when combined with regional anesthesia to reduce reliance on neuromuscular blockade, was associated with stable perioperative outcomes and preserved respiratory function when block height remained below T12. These findings emphasize the importance of minimizing NMBA exposure, tailoring anesthetic modality to baseline neurologic status, and closely monitoring for postoperative deterioration. One limitation of this review is that available evidence is restricted to case reports; however, given the rarity of CIDP, these represent the entirety of published perioperative data and were therefore included.

We identified emerging principles that can guide safer perioperative management and underscore the need for prospective studies to establish formal anesthetic guidelines for patients with CIDP. Although limited by small sample sizes, these findings highlight the need for individualized perioperative strategies and prospective data to develop formal guidelines.