Devic’s disease: A devil’s trap for the Anesthesiologist: A case report

Abstract

Neuromyelitis optica spectrum of disorder (NMOSD) is a rare autoimmune inflammatory relapsing astrocytopathy due to immunoglobulin against aquaporin 4 (AQP4) receptor. It is characterized by demyelination of the spinal cord and optic nerve. The vulnerability of demyelinated neurons to local anesthetics and increased response to neuromuscular blocking agents make the choice of anesthesia challenging. The rarity of the disease has made the literature scarce, especially when it comes to those undergoing surgeries and their anesthetic implications. We report the case of a 54-year-old patient with NMOSD who underwent modified radical mastectomy for carcinoma breast under general anesthesia. The use of multimodal analgesia for pain management and the avoidance of muscle relaxants resulted in an uneventful perioperative period in this patient.