Major contraindications to neuraxial anesthesia include lack of consent, coagulation abnormalities, severe hypovolemia, elevated intracranial pressure (particularly with an intracranial mass), and infection at the site of injection. Other relative contraindications include severe aortic or mitral stenosis and severe left ventricular outflow obstruction (hypertrophic obstructive cardiomyopathy); however, with close monitoring and control of the anesthetic level, neuraxial anesthesia can be performed safely in patients with stenotic valvular heart disease, particularly if extensive dermatomal spread of anesthesia is not required (eg, “saddle” block spinal anesthetics).¹

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