SummaryIncreasing numbers of patients with spinal cord injury present for surgery or obstetric care. Spinal cord injury causes unique pathophysiological changes. The most important peri-operative dangers are autonomic dysreflexia, bradycardia, hypotension, respiratory inadequacy and muscle spasms. Autonomic dysreflexia is suggested by headache, sweating, bradycardia and severe hypertension and may be precipitated by surgery, especially bladder distension. Patients with low, complete lesions, undergoing surgery below the level of injury, may safely do so without anaesthesia provided there is no history of autonomic dysreflexia or troublesome spasms. An anaesthetist should be present to monitor the patient in this situation. General anaesthesia of sufficient depth is effective at controlling spasms and autonomic dysreflexia but hypotension and respiratory dysfunction are risks. There is a growing consensus that spinal anaesthesia is safe, effective and technically simple to perform in this group of patients. We present a survey of 515 consecutive anaesthetics in cord-injured patients and a review of the current literature on anaesthesia for patients with chronic spinal cord lesions. Dramatic improvements in the care of spinal cord injury patients have been achieved over the last few decades [1]. The active management of urinary tract and respiratory complications has lead to a decrease in mortality from renal and respiratory failure. Overall mortality decreased from over 80% at the time of World War I to less than 2% by the early 1980s. The implications of increased survival are an increase in the prevalence of spinal cord injuries, an increase in the numbers of patients presenting for elective surgery and an ever increasing number of spinal cord injured patients who develop further medical conditions as the result of normal ageing.Although the majority of spinal cord injured patients currently undergo elective surgery in specialised spinal units, the appearance of such patients on operating lists of other hospitals is likely to increase. Anaesthesia in the cord-injured patient poses unique difficulties. An understanding of the relevant pathophysiology assists in the provision of safe peri-operative care.

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