A Review on the Pathophysiology and Management of Anterior Spinal Artery Syndrome

The Potential of Granisetron in Preventing Spinal Anesthesia Induced Hypotension on Non-Obstetric Procedure

“…The artery of Adamkiweicz, the great radicular artery which arises from aorta between T9-L2, is the most common location for occlusion. [8,9] Most common etiology is usually due to aortic surgery induced direct hypotension or embolization, however, spinal anesthesia induced vasospasm to a radicular feeding artery and/or perioperative hypotension is considered as the underlying cause of ASAS. [7][8][9] It leads to hypoperfusion in the anterior spinal artery and resulting in ischemia or even infarction to the spinal cord.…”

“…[8,9] Most common etiology is usually due to aortic surgery induced direct hypotension or embolization, however, spinal anesthesia induced vasospasm to a radicular feeding artery and/or perioperative hypotension is considered as the underlying cause of ASAS. [7][8][9] It leads to hypoperfusion in the anterior spinal artery and resulting in ischemia or even infarction to the spinal cord. Therefore hypotension must be prevented in patients undergoing spinal Vol.8; Issue: 10; October 2021 anesthesia to avoid major complications such as ASAS.…”

“…Although some major surgery can induced direct hypotension or embolization to the anterior spinal artery branches, however, SAIH also contributed for this rare syndrome. [7][8][9] The mechanism behind spinal anesthesia-induced hypotension (SAIH) is believed due to sympathetic blockade induce venous blood pooling in the lowermost regions, which affects 20% of total blood circulation, hence decrease systemic vascular resistance, preload, and cardiac output. The decrease in preload will stimulate the mechanoreceptor and chemoreceptor on the left ventricle wall, which is serotonin sensitive.…”