No abstract

488 analgesia, including a similar event occurring several weeks later, we now use reduced amounts of narcotics intraoperatively in an attempt to reduce the possibility of postoperative apnoea. S. Intrapleural administration of 0.25%, 0.375%, and 0.5% bupivicaine with epinephrine after cholecystectomy. We read with interest the article on autonomic hyper-reflexia during extracorporeal shock-wave lithotripsy (ESWL) in quadriplegic patients by Chert and Castro (Can J Anaesth 1989; 36: 604-5). It is well known that a hypertensive crisis in quadri-plegic patients is precipitated by distension of the urinary bladder, dilatation of the anorectum, and during childbirth .t,2 The most probable cause of hypertension might be distention of the bladder. I have witnessed two cases of hypertensive crisis in quadriplegic patients who required catheterization of the bladder for operations not related to the bladder. In the first, the catheter became kinked and in the second the catheter was clamped by mistake and distension of the bladder ensued. Therefore distension of the bladder should be considered in their report. REFERENCES I Ciliberti B J, Goldfein J, Rovenstine EA. Hypertension during anesthesia in patients with spinal cord injuries. Anesthesiology 1954; 15: 273-9. CANADIAN JOURNAL OF ANAESTHESIA 2 Rocco AG, Vandam LD. Problems in anesthesia for paraplegics. Anesthesiology 1959; 20: 348-54. REPLY We agree that autonomic hyperreflexia may be provoked in quadriplegic patients by bladder distension, rectal distension and other gastrointestinal stimuli. It may also be triggered by exposure to cold, high temperature, decubitus formation, sunburn, thrombophlebitis, and puhnonary infarction, as well as tight clothing, supports, shoes, leg back strapping, and child birth. Each patient undergoing extracorporeal shock-wave litho-tripsy (ESWL) treatment for renal and ureteral calculi has bladder catheterization or urostomy drainage established prior to the procedure. Quadriplegic patients frequently have a urostomy drainage catheter in place. The bladder catheter monitors both the amount of hematuria and the discharge of stone fragments. Obstruction by the stone or gravel is more likely to result in ureteral or renal pelvic distention rather than bladder distention. Bladder distension caused by an obstructed or improperly functioning bladder catheter certainly can occur and should be prevented in the quadriplegic patient.

No abstract

No abstract

No abstract