From the Research
Anesthetic Response in Neuromyelitis Optica (NMO) Patients
- The anesthetic management of patients with NMO is challenging and controversial, requiring a multidisciplinary collaboration and careful consideration 1.
- Both neuraxial and general anesthesia have been used in patients with NMO, with some case reports describing successful use of spinal anesthesia for cesarean delivery 2.
- General anesthesia has also been used without developing adverse respiratory events or signs and symptoms of muscle weakness in a patient with NMO undergoing cesarean section 1.
- The risk factors of general anesthesia in pregnancy with NMO must be weighed against the likely risk of NMO relapse and the potential deteriorating neurological symptoms after neuraxial anesthesia 1.
- There is limited evidence on the anesthetic response in NMO patients, and more research is needed to guide anesthetic management decisions in this population.
Considerations for Anesthetic Management
- Patients with NMO may have increased intraoperative hyperalgesia requiring inhaled nitrous oxide/oxygen, as reported in a case of spinal anesthesia for cesarean delivery 2.
- The presence of anti-aquaporin 4 antibodies and the clinical manifestations of NMO, such as optic neuritis and extensive transverse myelitis, should be considered when planning anesthetic management 3, 4.
- The use of high-dose intravenous corticosteroids and plasma exchange sessions may be necessary to manage acute relapses of NMO, and anesthetic management should take into account the potential effects of these treatments 3, 4.