Navigating Anaesthesia Management for LSCS in a Patient with Neuromyelitis Optica Spectrum Disorder

Background: Neuromyelitis optica spectrum disorder (NMOSD) is a rare autoimmune demyelinating condition primarily affecting the optic nerves and spinal cord. Anaesthetic management during obstetric procedures is challenging due to the risk of disease exacerbation and limited literature. Case Presentation: We present a 36-year-old gravida 2 para 1 woman with NMOSD in remission, scheduled for elective lower segment caesarean section (LSCS) at 38 weeks due to cephalopelvic disproportion. Given concerns over neuraxial anaesthesia and potential relapse, general anaesthesia was chosen. Rapid sequence induction was performed with propofol and rocuronium, maintained with sevoflurane. Perioperative analgesia included multimodal agents and bilateral transversus abdominis plane block. Neuromuscular monitoring guided reversal with sugammadex. Discussion: General anaesthesia is a viable option in NMOSD patients when neuraxial techniques pose increased risk. Neuromuscular monitoring is essential due to altered sensitivity to muscle relaxants. Multimodal pain control and close neurological monitoring reduce the risk of postoperative flare-ups and chronic pain. Conclusion: A carefully tailored general anaesthesia approach with vigilant neuromuscular and neurological monitoring is safe and effective in NMOSD parturients undergoing LSCS. Collaborative care and individualized planning are key to favourable outcomes.