Tympa Grigoriadou Aliki, Asimakopoulos Thalis, Orfanou Christina, Melemeni Aikaterini, Tsaroucha Athanasia
1st Department of Anesthesiology, Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens, GRC.
Cureus. 2024 Feb 26;16(2):e54966. doi: 10.7759/cureus.54966. eCollection 2024 Feb.
Neuromyelitis optica (NMO), also known as Devic disease, poses unique challenges in obstetrical anesthesia, with limited research available. This case report presents the anesthetic management of a 43-year-old gravida 2 para 1 (G2P1) woman with NMO undergoing labor induction at 39 weeks of gestation. Having received uneventful epidural labor analgesia in her first pregnancy, she faced the delicate decision of neuraxial anesthesia in light of her NMO diagnosis, which was made following her initial pregnancy. Collaborative discussions resulted in the choice of labor epidural analgesia, and an indwelling epidural catheter was placed successfully. An unplanned cesarean section with effective epidural supplementation followed. The case highlights the intricacies of balancing pain relief and neurological risks in NMO patients. Existing literature reflects varying perspectives on neuraxial anesthesia in NMO, with reports both supporting and cautioning against its use. The case aligns with the current view that epidural labor analgesia appears safe in NMO, but conclusive recommendations await larger studies. The decision for neuraxial anesthesia in NMO should be individualized, guided by comprehensive pre-anesthetic counseling and ongoing research developments.
视神经脊髓炎（NMO），又称德维克病，在产科麻醉中带来了独特的挑战，相关研究有限。本病例报告介绍了一名43岁、孕2产1（G2P1）的患有视神经脊髓炎的女性在妊娠39周时引产的麻醉管理情况。她在首次怀孕时接受硬膜外分娩镇痛过程顺利，但鉴于其在首次怀孕后被诊断出患有视神经脊髓炎，此次面临着关于神经轴麻醉的微妙抉择。经过多方协作讨论，最终选择了分娩硬膜外镇痛，并成功置入了硬膜外留置导管。随后进行了一次计划外剖宫产，并辅以有效的硬膜外补充麻醉。该病例凸显了在视神经脊髓炎患者中平衡疼痛缓解与神经风险的复杂性。现有文献对视神经脊髓炎患者使用神经轴麻醉存在不同观点，既有支持的报道，也有对其使用持谨慎态度的报道。该病例与当前观点一致，即硬膜外分娩镇痛在视神经脊髓炎患者中似乎是安全的，但确凿的建议仍有待更大规模的研究。对视神经脊髓炎患者进行神经轴麻醉的决策应个体化，以全面的麻醉前咨询和不断发展的研究为指导。
