Anesthetic management for parturients with neurological disorders

Abstract

Anesthesia care for the pregnant and the parturient presenting with a neurological disease requires (1) expertise with neuroanesthesia and obstetric anesthesia care, (2) accurate physical examination of the neurological system preoperatively, (3) safe choice and conductance of the anesthesia technique (mostly regional anesthesia), (4) avoidance of unfavorable drug effects for the fetus and the nervous system of the mother, and (5) intraoperative neuromonitoring together with the control of the fetal heart rate. The most important message is that in the ideal case, any woman with a known, preexisting neurological disorder should discuss her plans to become pregnant with her physician before she becomes pregnant. Neurological diseases in pregnancy can be classified into three categories: (a) Pre-existent chronic neurological diseases such as epilepsy and multiple sclerosis (MS). (b) Diseases with onset predominantly in pregnancy such as some brain tumors or cerebrovascular events. (c) Pregnancy-induced conditions such as eclampsia and Hemolysis elevated liver enzymes and low platelets syndrome. This article addresses specific issues surrounding neurologic disease in pregnant women including MS parturient, spinal cord injury, parturient with increased intracranial pressure and shunts, parturient with brain tumors, Guillain-Barré syndrome and epilepsy.

The Use of Enhanced Recovery After Surgery Protocols and Sugammadex in a Friedreich Ataxia Patient Who Underwent Robotic Surgery: A Case Report of a Patient Who Required No Postoperative Opioids and Was Discharged Home Earlier Than Anticipated

“…For instance, regional anesthesia has safely and successfully been used in the FRDA patient population [9]. On the other hand, literature on the use of neuraxial anesthesia for patients with multiple sclerosis is less clear, reflecting the importance of tailoring the anesthetic approach to each patient individually [22].…”

Manejo anestésico de feocromocitoma en paciente con enfermedad de Von Hippel-Lindau

“…A pesar de que la bibliografía recomienda el uso de catéter epidural en el abordaje quirúrgico del feocromocitoma [11], en nuestro caso se desestimó por ser la paciente portadora de una derivación ventrículo peritoneal. Aunque la derivación ventriculoperitoneal no contraindica de forma absoluta la anestesia neuroaxial [12] preferimos utilizar otro plan analgésico. Por este motivo decidimos hacer un bloqueo regional antes del inicio de la cirugía que proporcionará una analgesia extra desde el inicio.…”

Anesthesia for a parturient with intraneural perineurioma

“…[ 17 ] We had no previous experience of managing intraneural perineurioma parturient and related literatures did not offer any meaningful practical advice. [ 18 – 20 ] We managed this case based on multidisciplinary consultation for reasonable expectations and experiences of managing parturients with other preexisting neurologic conditions such as neurofibromas.…”