Background and Aims Devic disease, or neuromyelitis optica, is a rare autoinflammatory demyelinating disease of the central nervous system, characterized by axonal damage, affecting mainly optic nerves and the spinal cord. The anesthetic management of a parturient suffering Devic disease in the delivery room, is presented.
Methods A 43-year-old, 90 kg, 167cm, G2P1 woman, diagnosed with Devic disease, presented for labor induction at 39 weeks of gestation. Initial neurologic symptoms, diplopia and facial nerve palsy, had developed during her first pregnancy and were diagnosed as brain stem syndrome in remission; the parturient received then uneventful epidural labor analgesia. A year later, Devic disease was diagnosed, further confirmed by positive NMO – IgG/anti-AQP4 antibody. Currently, during pre-anesthesia assessment, the risk of potential neurological symptoms deterioration after labor epidural was weighed against the risk of a labor stress-induced disease relapse. Anesthesiologist and Obstetrician communicated the planned procedure and its risks and the parturient opted for labor epidural analgesia.
Results An indwelling epidural catheter was placed uneventfully in the delivery room, ropivacaine 0.2% was administered and an adequate sensory block was established. An enhanced sensitivity to the local anesthetic, presumably deriving from spinal cord damage, was postulated, due to unilaterally denser sensory block. Length of catheter insertion into the epidural space was optimal. Several hours later, the parturient underwent cesarean section for obstetric indications after successful epidural top-up.
Conclusions This case illustrates the safe and effective use of epidural labor analgesia and anesthesia in a patient with Devic disease; thorough pre-anesthetic and obstetric counseling is vital.
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