General anaesthesia for caesarean section in a patient with neuromyelitis optica spectrum disorder (NMOSD)

Sasima Dusitkasem; Pattika Subsoontorn

doi:10.1016/j.ijscr.2019.03.057

General anaesthesia for caesarean section in a patient with neuromyelitis optica spectrum disorder (NMOSD)

Int J Surg Case Rep. 2019:60:72-74. doi: 10.1016/j.ijscr.2019.03.057. Epub 2019 Apr 5.

Authors

Sasima Dusitkasem¹, Pattika Subsoontorn²

Affiliations

¹ Department of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. Electronic address: sasima.dus@mahidol.ac.th.
² Department of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Abstract

Introduction: Neuromyelitis optica spectrum disorder (NMOSD) is a rare demyelinating disorder affecting the spinal cord and optic nerves. The anesthetic management in parturient women with NMOSD are controversial and remains challenging.

Presentation of case: A 35-year-old G2P1 woman at 36 weeks of gestation with NMOSD presented for pre-anesthesia assessment prior to caesarean section. Her NMOSD had been diagnosed four years previously and was treated with intravenous methylprednisolone (IVMP) and plasma exchange (PLEX). She underwent general anesthesia without developing adverse respiratory events or signs and symptoms of muscle weakness.

Discussion: Both neuraxial and general anaesthesia for NMOSD have been described in previous case reports. Risk factors of general anesthesia in pregnancy with NMOSD must be weighed against the likely risk of NMOSD relapse and the potential deteriorating neurological symptoms after neuraxial anesthesia.

Conclusion: A multidisciplinary collaboration together with careful anesthetic consideration is required for the anesthetic and perioperative management of these patients.

Keywords: Caesarean section; Demyelinating disease; General anaesthesia; Neuromyelitis optica spectrum disorder (NMOSD).