Neurologic Issues and Obstetric Anesthesia

Abstract

The rising popularity of regional anesthesia in the last several decades has greatly changed the experience of labor. Although the use of regional anesthesia has aided in decreasing maternal morbidity and mortality, a new dimension of neurologic issues, particularly headache and peripheral neuropathy, is apparent. Obstetric anesthesiologists frequently encounter patients with preexisting neurologic disease. Although very few of these disorders contraindicate the use of neuraxial technique, there are limited published data on specific neurologic and neuromuscular disorders in pregnancy. Neurologists are often consulted by anesthesiologists and obstetricians to evaluate pregnant patients for the feasibility of labor analgesia and when postpartum neurologic complications arise. Early consultation with an obstetric anesthesiologist, discussion with a neurologist, and communication with the obstetrician allows for the education and discussion of the risks and benefits of both the mode of delivery and anesthetic options. This multidisciplinary approach is crucial in forming reasonable expectations for the patient. The aim of this discussion is to provide an obstetric anesthesiologist's perspective on regional anesthesia and its implications in obstetrics, and to enhance communication between our specialties.

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.…”

“…Compression of the neurovascular supply is another possible mechanism. [ 20 ] Moreover, women often push during the second stage of labor in a lithotomy position with their thighs hyperflexed on the abdomen. This position may stretch nerves as they course from the pelvis to the lower extremities.…”

Neurologic Complications of Obstetric Anesthesia

“…A number of smaller studies also support the safety of spinal and epidural anesthesia in women with Chiari malformation type I. 4,[14][15][16][17][18] Syringomyelia Syringomyelia refers to a fluid-filled column within the spinal cord. It can be seen in 40% to 60% of patients with Chiari malformation type I.…”

“…T he advantages of neuraxial anesthesia (epidural and spinal anesthesia) over general anesthesia in pregnant women are well established. [1][2][3][4] The incidence of failed intubation is 8 times higher in pregnant women than among nonpregnant women, 5 and the incidence of fatal failed intubation is 13 times higher. 4,6 This is related to edema and capillary engorgement of the airway that occur with pregnancy and can be exacerbated in women who have preeclampsia.…”

“…[1][2][3][4] The incidence of failed intubation is 8 times higher in pregnant women than among nonpregnant women, 5 and the incidence of fatal failed intubation is 13 times higher. 4,6 This is related to edema and capillary engorgement of the airway that occur with pregnancy and can be exacerbated in women who have preeclampsia. Pregnant women desaturate more quickly when difficulty in intubating is encountered because of decreased lung capacity from the uterus pressing up against the diaphragm.…”