Reviews | Challenge Journal of Perioperative Medicine

Neuraxial anesthesia in pregnant patients with neurological disorders ‒ Safety and practice strategies: A review

Mehmet Akif Yilmaz, Nuray Uzun


DOI: https://doi.org/10.20528/cjpm.2025.01.003
View Counter: Abstract | 113 times | ‒ Full Article | 29 times |

Full Text:

PDF

Abstract


Pregnant patients with neurological disorders face multifaceted challenges arising from both the physiological changes of pregnancy and the underlying neurological conditions. In this unique patient population, anesthesia management requires meticulous planning to ensure maternal and fetal safety while minimizing the risk of neurological complications. Neuraxial anesthesia emerges as a safe and effective option when implemented with appropriate patient selection, a multidisciplinary approach, and individualized anesthesia protocols. This review comprehensively evaluates the clinical benefits of neuraxial anesthesia in pregnant patients with neurological disorders, highlighting critical considerations in its application and potential risks. Drawing upon the existing body of evidence, it aims to promote the safe use of neuraxial techniques and enhance awareness of the challenges inherent in managing this patient group. Additionally, the review underscores the importance of anesthesiologists adopting individualized strategies that address the specific risks associated with neurological pathologies, optimizing the advantages of neuraxial anesthesia in obstetric care.


Keywords


neurologic disorder; pregnancy complications; anesthesia obstetrical; anesthesia epidural; anesthesia spinal

References


Lowe NK. The nature of labor pain. Am J Obstet Gynecol. 2002;186(5 Suppl Nature):S16-24.

Ranta P, Spalding M, Kangas-Saarela T, Jokela R, Hollmén A, Jouppila P, et al. Maternal expectations and experiences of labour pain--options of 1091 Finnish parturients. Acta Anaesthesiol Scand. 1995;39(1):60-6.

ACOG Practice Bulletin No. 209: Obstetric Analgesia and Anesthesia. Obstet Gynecol. 2019;133(3):e208-e25.

Brownridge P. The nature and consequences of childbirth pain. Eur J Obstet Gynecol Reprod Biol. 1995;59 Suppl:S9-15.

Minnich ME, Brown M, Clark RB, Miller FC, Thompson DS. Oxygen desaturation in women in labor. J Reprod Med. 1990;35(7):693-6.

Rooth G. Maternal hypoxaemia during labor. Padiatr Padol. 1982;17(2):231-6.

Tomimatsu T, Kakigano A, Mimura K, Kanayama T, Koyama S, Fujita S, et al. Maternal carbon dioxide level during labor and its possible effect on fetal cerebral oxygenation: mini review. J Obstet Gynaecol Res. 2013;39(1):1-6.

Hägerdal M, Morgan CW, Sumner AE, Gutsche BB. Minute ventilation and oxygen consumption during labor with epidural analgesia. Anesthesiology. 1983;59(5):425-7.

Shnider SM, Wright RG, Levinson G, Roizen MF, Wallis KL, Rolbin SH, et al. Uterine blood flow and plasma norepinephrine changes during maternal stress in the pregnant ewe. Anesthesiology. 1979;50(6):524-7.

Vogl SE, Worda C, Egarter C, Bieglmayer C, Szekeres T, Huber J, et al. Mode of delivery is associated with maternal and fetal endocrine stress response. Bjog. 2006;113(4):441-5.

Traynor AJ, Aragon M, Ghosh D, Choi RS, Dingmann C, Vu Tran Z, et al. Obstetric Anesthesia Workforce Survey: A 30-Year Update. Anesth Analg. 2016;122(6):1939-46.

Jones L, Othman M, Dowswell T, Alfirevic Z, Gates S, Newburn M, et al. Pain management for women in labour: an overview of systematic reviews. Cochrane Database Syst Rev. 2012;2012(3):Cd009234.

Olofsson C, Ekblom A, Ekman-Ordeberg G, Hjelm A, Irestedt L. Lack of analgesic effect of systemically administered morphine or pethidine on labour pain. Br J Obstet Gynaecol. 1996;103(10):968-72.

Smith LA, Burns E, Cuthbert A. Parenteral opioids for maternal pain management in labour. Cochrane Database Syst Rev. 2018;6(6):Cd007396.

Likis FE, Andrews JC, Collins MR, Lewis RM, Seroogy JJ, Starr SA, et al. Nitrous oxide for the management of labor pain: a systematic review. Anesth Analg. 2014;118(1):153-67.

Girault A, Dommergues M, Nizard J. Impact of maternal brain tumours on perinatal and maternal management and outcome: a single referral centre retrospective study. Eur J Obstet Gynecol Reprod Biol. 2014;183:132-6.

Finfer SR. Management of labour and delivery in patients with intracranial neoplasms. Br J Anaesth. 1991;67(6):784-7.

Kasper EM, Hess PE, Silasi M, Lim KH, Gray J, Reddy H, et al. A pregnant female with a large intracranial mass: Reviewing the evidence to obtain management guidelines for intracranial meningiomas during pregnancy. Surg Neurol Int. 2010;1:95.

Bédard JM, Richardson MG, Wissler RN. General anesthesia with remifentanil for Cesarean section in a parturient with an acoustic neuroma. Can J Anaesth. 1999;46(6):576-80.

Draisci G, Valente A, Suppa E, Frassanito L, Pinto R, Meo F, et al. Remifentanil for cesarean section under general anesthesia: effects on maternal stress hormone secretion and neonatal well-being: a randomized trial. Int J Obstet Anesth. 2008;17(2):130-6.

Ngan Kee WD, Khaw KS, Ma KC, Wong AS, Lee BB, Ng FF. Maternal and neonatal effects of remifentanil at induction of general anesthesia for cesarean delivery: a randomized, double-blind, controlled trial. Anesthesiology. 2006;104(1):14-20.

Imarengiaye C, Littleford J, Davies S, Thapar K, Kingdom J. Goal oriented general anesthesia for Cesarean section in a parturient with a large intracranial epidermoid cyst. Can J Anaesth. 2001;48(9):884-9.

Van de Velde M, Teunkens A, Kuypers M, Dewinter T, Vandermeersch E. General anaesthesia with target controlled infusion of propofol for planned caesarean section: maternal and neonatal effects of a remifentanil-based technique. Int J Obstet Anesth. 2004;13(3):153-8.

Scott C, Kaliaperumal C. Idiopathic intracranial hypertension and pregnancy: A comprehensive review of management. Clin Neurol Neurosurg. 2022;217:107240.

Gragasin FS, Chiarella AB. Use of an Intrathecal Catheter for Analgesia, Anesthesia, and Therapy in an Obstetric Patient with Pseudotumor Cerebri Syndrome. A A Case Rep. 2016;6(6):160-2.

Moore DM, Meela M, Kealy D, Crowley L, McMorrow R, O'Kelly B. An intrathecal catheter in a pregnant patient with idiopathic intracranial hypertension: analgesia, monitor and therapy? Int J Obstet Anesth. 2014;23(2):175-8.

Palop R, Choed-Amphai E, Miller R. Epidural anesthesia for delivery complicated by benign intracranial hypertension. Anesthesiology. 1979;50(2):159-60.

Bedson CR, Plaat F. Benign intracranial hypertension and anaesthesia for caesarean section. Int J Obstet Anesth. 1999;8(4):288-90.

Pagani-Estévez GL, Chen JJ, Watson JC, Leavitt JA. Acute Vision Loss Secondary to Epidural Blood Patch: Terson Syndrome. Reg Anesth Pain Med. 2016;41(2):164-8.

Aly EE, Lawther BK. Anaesthetic management of uncontrolled idiopathic intracranial hypertension during labour and delivery using an intrathecal catheter. Anaesthesia. 2007;62(2):178-81.

Miller EC, Leffert L. Stroke in Pregnancy: A Focused Update. Anesth Analg. 2020;130(4):1085-96.

Wang A, Saad AF. Hemorrhagic Stroke in Pregnancy. Clin Obstet Gynecol. 2023;66(1):223-30.

Ellwood SJ, Mootz AA, Carabuena JM, Farber MK, Reale SC. Management of sporadic intracranial vascular malformations in pregnancy: a retrospective analysis. Int J Obstet Anesth. 2024;58:103989.

von Knobelsdorff G, Paris A. Intracerebral hemorrhage after cesarean section under spinal anesthesia. Coincidence or causality? Anaesthesist. 2004;53(1):41-4.

Eggert SM, Eggers KA. Subarachnoid haemorrhage following spinal anaesthesia in an obstetric patient. Br J Anaesth. 2001;86(3):442-4.

Choi CK, Tyagaraj K. Combined spinal-epidural analgesia for laboring parturient with Arnold-Chiari type I malformation: a case report and a review of the literature. Case Rep Anesthesiol. 2013;2013:512915.

Chantigian RC, Koehn MA, Ramin KD, Warner MA. Chiari I malformation in parturients. J Clin Anesth. 2002;14(3):201-5.

Landau R, Giraud R, Delrue V, Kern C. Spinal anesthesia for cesarean delivery in a woman with a surgically corrected type I Arnold Chiari malformation. Anesth Analg. 2003;97(1):253-5, table of contents.

Waters JFR, OʼNeal MA, Pilato M, Waters S, Larkin JC, Waters JH. Management of Anesthesia and Delivery in Women with Chiari I Malformations. Obstet Gynecol. 2018;132(5):1180-4.

Yamada S, Won DJ, Yamada SM, Hadden A, Siddiqi J. Adult tethered cord syndrome: relative to spinal cord length and filum thickness. Neurol Res. 2004;26(7):732-4.

O'Neal MA. A Pregnant Woman with Spina Bifida: Need for a Multidisciplinary Labor Plan. Front Med (Lausanne). 2017;4:172.

Garvey GP, Wasade VS, Murphy KE, Balki M. Anesthetic and Obstetric Management of Syringomyelia during Labor and Delivery: A Case Series and Systematic Review. Anesth Analg. 2017;125(3):913-24.

Hebl JR, Horlocker TT, Kopp SL, Schroeder DR. Neuraxial blockade in patients with preexisting spinal stenosis, lumbar disk disease, or prior spine surgery: efficacy and neurologic complications. Anesth Analg. 2010;111(6):1511-9.

Moen V, Dahlgren N, Irestedt L. Severe neurological complications after central neuraxial blockades in Sweden 1990-1999. Anesthesiology. 2004;101(4):950-9.

Bédard JM, Richardson MG, Wissler RN. Epidural anesthesia in a parturient with a lumboperitoneal shunt. Anesthesiology. 1999;90(2):621-3.

Kaul B, Vallejo MC, Ramanathan S, Mandell GL, Krohner RG. Accidental spinal analgesia in the presence of a lumboperitoneal shunt in an obese parturient receiving enoxaparin therapy. Anesth Analg. 2002;95(2):441-3, table of contents.

Metterlein T, Kuenzig H, Bele S, Brawanski A, Graf BM. Coma after spinal anaesthesia in a patient with an unknown intracerebral tumour. Acta Anaesthesiol Scand. 2010;54(9):1149-51.

Alves S, Sousa N, Cardoso L, Alves J. Multidisciplinary management of idiopathic intracranial hypertension in pregnancy: case series and narrative review. Braz J Anesthesiol. 2022;72(6):790-4.


Refbacks

  • There are currently no refbacks.