Assessment of cardiac and respiratory function during surgery on patients with acute quadriplegia

Mackenzie, Colin F.; Shin, Beomsu; Krishnaprasad, Deepika; McCormack, Frank C.; Illingworth, William

doi:10.3171/jns.1985.62.6.0843

Cited by 38 publications

(5 citation statements)

References 10 publications

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“…Esto se traduce en una disminución de las posibilidades de adaptación ante pequeñas variaciones de la volemia, mayor sensibilidad a movimientos, cambios de posición y aumentos de presión intratorácica (ventilación mecánica). Las lesiones medulares altas se asocian a una menor tolerancia a la sobrecarga de volumen, debido a depresión cardiaca producto de la denervación simpática [47]. La persistencia de un sistema parasimpático eficiente, explica la bradicardia habitual de estos pacientes, máxima al cuarto día [48].…”

Section: Shock Medular O Espinalunclassified

Traumatismo raquimedular

Bozzo¹

2021

Rev. chil. anest.

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According to different publications, the neurological level most frequently involved in traumatic spinal cord injury is cervical (16%-75%), followed by thoracic (16%-36%) and lumbar (9%-17%). The abrupt interruption of nerve conduction at the spinal level causes spinal shock, characterized by an acute neurological, hemodynamic, respiratory and urinary compromise, which associates with thermoregulation problems. Neurological repercussions are characterized by a motor compromise, evidenced as flaccid paralysis with areflexia, sensory damage, abolition of sympathetic activity and loss of adaptive reflexes in the territory located below the lesion. The management of traumatic spinal cord, both, isolated or associated with multiple trauma, must begin at the scene of the accident. The current trend is towards a selective immobilization identifiying the group of patients in whom it will have a real benefit. Clinical features of spinal shock and other clinical aspects of the spinal cord injury are described in detail. Diagnosis should include a complete neurological examination including imaging studies. The type of image of choice is computerized axial tomography (CT). Different treatment alternatives are analyzed, including early or delayed descompressive surgery, methylprednisolone, neuroprotection and neuroregeneration. Finally, anesthetic management is described, the objective of which should be to reduce the movement of the lesion area (especially during positioning and the laryngoscopy and intubation maneuver) and to maintain the medullary perfusion pressure within normal limits. Postoperative care should focus on pain management, prevention of thromboembolic events and weaning from mechanical ventilation. RESUmENEl nivel neurológico más frecuentemente comprometido en las lesiones raquimedulares por trauma es el cervical (16%-75%), seguido del torácico (16%-36%) y lumbar (9%-17%) según diferentes publicaciones. La brusca interrupción de la conducción nerviosa a nivel medular origina el cuadro de shock medular, caracterizado por un agudo compromiso neurológico, hemodinámico, respiratorio y urinario, asociado a problemas de termorregulación, con repercusiones neurológicas caracterizadas por un compromiso motor que se manifiesta como una parálisis fláccida con arreflexia, daño sensitivo, desaparición de la actividad simpática y pérdida de reflejos de adaptación en el territorio ubicado por debajo de la lesión. El manejo del trauna ra-

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Section: Shock Medular O Espinalunclassified

Traumatismo raquimedular

Bozzo¹

2021

Rev. chil. anest.

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“…55 MacKenzie also recommends that hypotension should be treated with fluid and inotropic agents rather than direct vasoconstrictors because of the presence of cardiac dysfunction, ss…”

Section: Maintenance Of Anaesthesiamentioning

confidence: 99%

Acute spinal cord injury: monitoring and anaesthetic implications

Lam

1991

Can J Anaesth

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The incidence of spinal cord injuries in North America is estimated to be 15-50 per million population. 1,2 In the U.S. this means approximately 12,000 new cases per year with a mortality approaching 50% and a prevalence of 200,000. I Most victims are young (15-24 yr) 2 and the survivors end up with debilitating neurological deficits although the development of regional spinal cord injury centres as well as improved treatment have reduced the incidence of complete lesions from 65% to 45%. 3 The major causes are motor vehicle accidents, falls, sports and recreational injuries, and other violent causes. Alcohol and recreational drug use are frequently contributing factors. Mechanism and classification of spinal cord injuryInjuries in the cervical spine are generally caused by (1) flexion, (2) flexion-rotation, (3) vertical compression (axial loading), (4) extension, (5) extension-rotation, (7) lateral flexion. 4 The mechanism of injury in the thoracolumbar spine is similar except that there is less mobility and injuries are more likely due to compression and rotational forces.The three-column concept 5 of the structure of the vertebral column helps to clarify the mechanism of injury. The posterior column is formed by the posterior neural arch, spinous process, facetal articular processes, and their corresponding posterior ligamentous complex. The middle column consists of the posterior one-third of the vertebral body and annulus fibrosus and the posterior longitudinal ligament. The anterior column comprises the anterior longitudinal ligament and the anterior two-thirds of the vertebral body and annulus fibrosus. Flexion injury causes disruption of the posterior column and extension injury causes disruption of the anterior column. If two or more columns are disrupted, then acute spinal instability exists and predicts the possibility of late instability. Spinal cord injuries most frequently involve the lower cervical spine and the thoracolumbar junction, the former because of its mobility, and the latter because it is the junction between the rigid thoracic spine and the flexible lumbar spine. The paediatric and the elderly spineUntil ten years of age the immature spine has increased physiological mobility due to ligamentous laxity, and incompletely ossified wedge-shaped vertebrae, which afford them some protection against spinal column injuries but at the same time increase the incidence of spinal cord injury without radiographic abnormality. 6-s The elderly patient, on the other hand, with the development of degenerative changes and osteophytes, and narrowing of the spinal canal, may develop spinal cord injury even with trivial trauma and the injury may be missed. 9Spinal cord injuries can be complete with loss of all motor and sensory function below the level of injury, or incomplete including the central cord syndrome, the Brown-Sequard syndrome, the anterior cord syndrome and the posterior cord syndrome. Normal physiology of the spinal cord Spinal cord circulationThe anterior two-thirds of the spinal cord are s...

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“…The blood volume of patients with SCI is reduced by approximately 20% [7]. However, congestive heart failure may occur, particularly if fluids are administered injudiciously [3] [8]. Therefore, the question still without answer: how much and which fluids?…”

mentioning

confidence: 99%

Volemic replacement during spinal cord injury patients.

Bermúdez

2019

Central European Journal of Clinical Research

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Assessment of cardiac and respiratory function during surgery on patients with acute quadriplegia

Cited by 38 publications

References 10 publications

Traumatismo raquimedular

Traumatismo raquimedular

Acute spinal cord injury: monitoring and anaesthetic implications

Volemic replacement during spinal cord injury patients.

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