[Spinal anesthesia for cesarean section in a patient with multiple sclerosis]. 2013

Sueko Oouchi, and Hirofumi Nagata, and Haruo Ookawa, and Tomoko Oikawa, and Yoko Iwabuchi, and Kenji S Suzuki
Department of Anesthesiology, School of Medicine, Iwate Medical University, Morioka 020-8505.

Spinal anesthesia is thought to be contraindicated for patients with multiple sclerosis (MS). We describe the case of a patient with MS who was administered spinal anesthesia for cesarean section. A 29-year-old woman (weight 55.8 kg, height 154 cm) with MS underwent an urgent cesarean section in the 39th week of her pregnancy for fetal malpresentation. Although the patient had experienced repeated relapses of MS thrice since she was 19, she had remained in remission since the age of 27, and did not have significant neurological disability. A 27 G needle (pencil type) was used for arachnoid puncture, and 0.5% hyperbaric bupivacaine (2.0 ml) was administered to the subarachnoid space at the L3-4 interspace. After confirming that the sensory blockade after spinal anesthesia had spread to T4, cesarean section was performed. For the subsequent 19 months, no remission of MS was recognized. Thus, spinal anesthesia does not seem to be contraindicated for patients with MS in remission state.

UI MeSH Term Description Entries
D009103 Multiple Sclerosis An autoimmune disorder mainly affecting young adults and characterized by destruction of myelin in the central nervous system. Pathologic findings include multiple sharply demarcated areas of demyelination throughout the white matter of the central nervous system. Clinical manifestations include visual loss, extra-ocular movement disorders, paresthesias, loss of sensation, weakness, dysarthria, spasticity, ataxia, and bladder dysfunction. The usual pattern is one of recurrent attacks followed by partial recovery (see MULTIPLE SCLEROSIS, RELAPSING-REMITTING), but acute fulminating and chronic progressive forms (see MULTIPLE SCLEROSIS, CHRONIC PROGRESSIVE) also occur. (Adams et al., Principles of Neurology, 6th ed, p903) MS (Multiple Sclerosis),Multiple Sclerosis, Acute Fulminating,Sclerosis, Disseminated,Disseminated Sclerosis,Sclerosis, Multiple
D011247 Pregnancy The status during which female mammals carry their developing young (EMBRYOS or FETUSES) in utero before birth, beginning from FERTILIZATION to BIRTH. Gestation,Pregnancies
D011248 Pregnancy Complications Conditions or pathological processes associated with pregnancy. They can occur during or after pregnancy, and range from minor discomforts to serious diseases that require medical interventions. They include diseases in pregnant females, and pregnancies in females with diseases. Adverse Birth Outcomes,Complications, Pregnancy,Adverse Birth Outcome,Birth Outcome, Adverse,Complication, Pregnancy,Outcome, Adverse Birth,Pregnancy Complication
D002585 Cesarean Section Extraction of the FETUS by means of abdominal HYSTEROTOMY. Abdominal Delivery,Delivery, Abdominal,C-Section (OB),Caesarean Section,Postcesarean Section,Abdominal Deliveries,C Section (OB),C-Sections (OB),Caesarean Sections,Cesarean Sections,Deliveries, Abdominal
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults
D000775 Anesthesia, Spinal Procedure in which an anesthetic is injected directly into the spinal cord. Anesthesias, Spinal,Spinal Anesthesia,Spinal Anesthesias

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