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We present two cases of automatic hyperreflexia (,411) Autonomic hyperrcflexia occurs in about 85% of patients with spinal !esion above the level of "1"6. 2 This can be caused by noxious stimuli such as distention of the bladder, cervix, or rectum, which evoke a mass triggering of sympathetic and parasympathetic afferents below the level of the cord lesion that are not inhibited by supraspinal centres. Autonomic hyperreflexia is a serious complication during pregnancy, labour and delivery in the patient with spinal cord injury) We present two cases of AH during labour in women with spinal cord damage and comment upon the efficacy of epidural anaesthesia in managing the syndrome. Case reports Case #1The 33-yr-old white woman was admitted at the 37th week of gestation. She had become quadriplegic at the age of 16 yr following a spinal cord injury at the C3-5 level. Neurological examination revealed loss of sensory, motor, and reflex function below the C6 level and partial motor function at the C6 level. Although there was no evidence of preterm labour, an epidural catheter was placed in the I-,z-L3 epidural space, because she exhibited signs suggestive of AH such as facial flushing, sweating, and piloerection during abdominal distension or vaginal examination. The epidural catheter was placed at the 37th week of gestation and was kept in situ until its removal after delivery. No AH was observed with the epidural injection of 5 to l0 ml lidocaine 1%, given before each vaginal examination. At the 40th week of gestation, symptoms of AH such as pounding headache, hypertension, CAN J A N A E S T H 1995 / 4 2 : 1 2 / pp il34-6

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