A & A case reports
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Neuromyelitis optica (NMO), or Devic's disease, is an idiopathic severe demyelinating disease that preferentially affects the optic nerve and spinal cord. Neuraxial anesthesia in women with multiple sclerosis is widely accepted, but reports of the use of neuraxial anesthesia in patients with NMO are scarce. We report the case of a morbidly obese primigravida undergoing a planned cesarean delivery at 32 weeks' gestation due to an acute exacerbation of NMO, managed with spinal anesthesia. Other than increased intraoperative hyperalgesia requiring inhaled nitrous oxide/oxygen, the mother experienced no apparent anesthetic-related complications.
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Methylene blue, a drug used to treat vasoplegia and methemoglobinemia, also inhibits monoamine oxidase-A. When given in combination with serotonergic medications, methylene blue can lead to serotonin excess syndrome. ⋯ Patients undergoing cardiopulmonary bypass for cardiac surgery are a specific population at risk for postbypass vasoplegic shock. The use of methylene blue to treat vasoplegia in this group of patients should be weighed in light of their current medications and potential drug interactions.