Altered cardiovascular responses to tracheal intubation in patients with complete spinal cord injury: relation to time course and affected level

Abstract

The cardiovascular and catecholamine responses to intubation change as a function of the time elapsed and the level of the cord injury. In this study, the pressor response to tracheal intubation was abolished in the quadriplegics but not in paraplegics; indeed, it was enhanced at 10 yr or more since injury in this group.

Cardiac arrhythmias associated with spinal cord injury

“…9 After high-level SCI the spinal sympathetic pathways involved in maintaining HR are disrupted, leaving the heart with unopposed parasympathetic vagal tone 40 . This imbalance creates vulnerability to exogenous stimuli such as tracheal suction, 26 but also to spontaneous episodes of bradycardia. 9 The incidence of bradycardia peaked at days 4-6 8,9,12 (Fig.…”

“…In the specific exposure category ( Table 3) the authors studied the response in HR to various stimuli including effects of exercise, penile vibro-stimulation, tracheal suction and intubation, facial water-immersion, and tilting in individuals with SCI. 8,15,16,[20][21][22][23][24][25][26] Claydon et al 15 reported that 6 of 13 male participants with cervical SCI developed new bradycardia when undergoing penile vibro-stimulation for sperm retrieval. Furthermore, some of these participants had episodes of atrial premature beats and VPB during or after the procedure.…”

“…The severity or level of neurological injury had no influence on the results of this study. Yoo et al 26 divided their 214 participants in to groups categorized by level and time after injury (Table 3). They reported that individuals, with acute SCI <4 weeks, developed bradycardia more often than able-bodied controls, when being intubated before surgery.…”

Emergency Neurological Life Support: Traumatic Spine Injury

“…Therefore, medications that further diminish the catecholamine surge may result in exacerbation of hypotension and bradycardia [25,26]. Tracheal or laryngeal manipulation can also stimulate a bradycardic response in these patients, as can any degree of hypoxia [27,28].…”