Anesthetic Considerations in a High-Risk Pregnant Patient With Myelomeningocele and Urosepsis Undergoing Emergent Surgery: A Case Report.

The patient was a pregnant 30-year-old gravida 6, para 0 (G6P0) woman at 22 weeks and four days (22w4d) with myelomeningocele and neurogenic bladder who presented with progressive pain, fevers, chills, and transaminitis concerning for urosepsis requiring emergent cystolithalopaxy. Preoperative evaluation identified marked lower-extremity weakness. Anesthetic considerations included the safety of neuraxial anesthesia and concerns regarding neuromuscular blockade and reversal. Neuraxial anesthesia was avoided due to myelomeningocele, and succinylcholine was avoided due to concern for hyperkalemia. Rocuronium was used, with sugammadex administration for neuromuscular blockade reversal following consultation with obstetrics. The case proceeded uneventfully.