Neurologic Complications of Obstetric Anesthesia

The advantages of neuraxial anesthesia over general anesthesia in the obstetric population are well established. Some neurologic conditions have the potential to lower the safety threshold for administration of neuraxial anesthesia, whereas others require special consideration before using general anesthesia. The aim of this article is to help neurologists determine when neuraxial anesthesia can be safely administered and when it is inadvisable.

Neuraxial anesthesia can usually be given safely in most pregnant patients with neurologic disease. Patients with mass lesions causing increased intracranial pressure or spinal tumors at the site of neuraxial needle placement and patients on anticoagulant medication are the exceptions. Post-dural puncture headaches and obstetric nerve injuries are the most common complications of neuraxial anesthesia and resolve in most patients. Other complications, including epidural hematoma, meningitis, and epidural abscess, are rare but devastating.

This article provides a review of neurologic diseases that may affect the decision-making process for anesthesia during delivery. It discusses the neurologic complications that can occur because of obstetric anesthesia and how to recognize them and describes obstetric nerve injuries and how to distinguish these relatively benign injuries from more serious complications.