Study design: Pharmacologically blocking the spinal cord produces sedative effects and reduces anesthesia requirements in patients and animals. Whether spinal cord injury also reduces anesthesia requirements remains unclear. Methods: We retrospectively analyzed data from urethane-anesthetized rats 15 to assess anesthesia requirements immediately after complete thoracic transection of the spinal cord. The depth of anesthesia was monitored up to 12 h after spinal transection by the reflexes to noxious stimuli and by electrophysiological recordings from the infragranular layers of the primary somatosensory cortex. Whenever animals displayed electrophysiological and/or behavioral signs of activation, we delivered an additional dose of anesthesia. Anesthetic requirements in animals receiving spinal transection (n ¼ 11) were compared with control animals receiving 'sham' lesion (n ¼ 9). Results: The cumulative dose necessary to maintain a stable level of anesthesia was significantly lower in transected animals compared with control animals. By about 7 h after spinal cord injury, on average the cumulative dose of urethane was only 1.13 ± 0.14 of the original dose, compared with 1.64 ± 0.19 of the original dose in control animals. Conclusions: Spinal transection immediately decreased anesthetic requirements in rats. To establish whether these results are relevant for patients with spinal cord injury will require further investigation.

Pressure sores, and especially ischial pressure sores, are a serious concern in the life of paraplegic patients. The treatment of this pathology is obviously surgery, and several local flaps can be used for coverage. However, recurrent pressure sores in an active patient can be frustrating if all local flaps have been used. Free flaps are therefore the next option. In our experience, the free medial gastrocnemius musculocutaneous flap is the best option. This paper reports the closure of ischial pressure sores with a free medial gastrocnemius flap, the patient selection criteria used, and the postoperative care provided.