Autonomic Dysreflexia During Urodynamic Examinations in Patients With Suprasacral Spinal Cord Injury

Huang, Yu-Hui; Bih, Liu-Ing; Chen, Gin‐Den; Lin, Chuan-Chao; Chen, Sung‐Lang; Chen, Weiwen

doi:10.1016/j.apmr.2011.03.024

Cited by 39 publications

(62 citation statements)

References 23 publications

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“…This is similar to a previous report using the same definition of AD reaction (SBP increment 420 mmHg). 12 Among these patients with signs of AD, 50% were symptomatic and 50% were silent. This percentage of silent AD is higher than three previous studies that reported 35, 38 and 43% respectively.…”

Section: Discussionmentioning

confidence: 99%

“…13 An SBP elevation 420 mmHg was defined as AD reaction, and these patients were enrolled for the final analysis. 12 The execution and reading of UD examinations followed the standards of the International Continence Society. 14 Cystourethrometry was performed by a triple-lumen catheter with continuous filling of isotonic saline at a rate of 30 ml min À1 .…”

Section: Methodsmentioning

confidence: 99%

“…However, that study used a fixed level of BP (systolic BP 160 mmHg and diastolic BP 90 mmHg) as a definition of AD, which is different from more recent concepts that define increments of 20-40 mmHg from resting SBP as an AD episode. [10][11][12] As silent AD may be an important clinical concern regarding the health of the SCI patients, the present study sought to discover the factors associated with AD symptoms and investigate the mechanisms underlying silent AD. In this study, BP and its symptoms were monitored throughout each UD examination, and an SBP increment 420 mmHg was defined as an AD reaction.…”

Section: Introductionmentioning

confidence: 99%

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Blood pressure and age associated with silent autonomic dysreflexia during urodynamic examinations in patients with spinal cord injury

et al. 2012

Spinal Cord

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Study design: An observational study. Objectives: To investigate the factors associated with silent autonomic dysreflexia (AD) during urodynamics (UD) in spinal cord injury (SCI) patients. Setting: Taichung city, Taiwan, ROC. Methods: Blood pressure (BP) and symptoms of AD were continuously monitored during UD, and systolic blood pressure (SBP) elevations 420 mmHg was considered an AD reaction. AD patients were divided into a symptomatic group and a silent group (without AD symptoms), and variables (basic demographic data, hemodynamic data and UD parameters) were compared. Results: A total of 42 patients, 21 in symptomatic and 21 in silent AD groups, were analyzed. Symptomatic group had significantly greater diastolic blood pressure (DBP) increment and rates of SBP/DBP changes (change of BP divided by duration) as compared to the silent group (29.5 vs 21.7 mmHg; 4.8 vs 2.3 mmHg min À1 and 2.8 vs 1.4 mmHg min À1 ) (Po0.05). The cutoff points of these three variables, determined by receiver operating characteristic analysis, are: DBP increment of 21 mmHg and rates of SBP/DBP change of 2.27 and 1.16 mmHg min À1 . Age had a weak negative correlation with DBP change (Pearson's r ¼ À0.377, P ¼ 0.048) and the silent group was significantly older than the symptomatic group (49.4 vs 40.1 years, Po0.05). Conclusion: Patients with more symptomatic AD tended to have significant DBP elevation and more rapid SBP/DBP increments, and this was negatively correlated with age. Aging decreases AD symptoms and the magnitude of DBP elevation, possibly through the mechanism of decreased baroreceptor sensitivity. BP monitoring during UD and other invasive procedures is strongly recommended, especially for elderly SCI patients.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Blood pressure and age associated with silent autonomic dysreflexia during urodynamic examinations in patients with spinal cord injury

et al. 2012

Spinal Cord

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“…2 One of the most common physician-induced causes of AD in individuals with SCI is the use of procedures that involve urinary bladder and urogenital areas. 3 Previously, numerous studies using different groups of individuals with SCI examined CV responses either during urodynamic [3][4][5][6] or cystoscopic examination. 7,8 These two procedures both involve urinary bladder distension.…”

Section: Introductionmentioning

confidence: 99%

Autonomic dysreflexia severity during urodynamics and cystoscopy in individuals with spinal cord injury

Liu

Fougere

et al. 2013

Spinal Cord

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Study Design: Retrospective chart review. Objective: To compare autonomic dysreflexia (AD) severity during urodynamics and cystoscopy in individuals with spinal cord injury (SCI). Setting: Outpatient urological clinic. Methods: Demographic and clinical data were collected from charts of individuals with SCI who had blood pressure (BP) monitoring during urological procedures. Cardiovascular parameters were collected at baseline and during the various stages of two examinations. Results: A total of 21 SCI individuals (mean age 49.4 years) who underwent both procedures developed episodes of AD. The majority of individuals had cervical SCI (85.7%). The median duration of injury was 183 months (ranging from 3 to 530 months). There was statistically more of an increase (P ¼ 0.039) in systolic BP during cystoscopy (67.1 ± 33.8 mm Hg) in comparison with urodynamics (51.8±21.8 mm Hg). The BP response during episodes of AD was more pronounced in individuals with more than 2 years post SCI than with less than 2 years post SCI during both urodynamics and cystoscopy (P ¼ 0.047 and P ¼ 0.010, respectively). Conclusion: Even though cystoscopy filled the bladder to lesser volumes than did urodynamics (150 ml vs 500 ml), during cystoscopy the individuals developed greater changes in systolic BP, indicating that stimulation of the urethra/prostate/internal sphincter region probably is a more potent stimulus of AD than just the filling of the bladder. The severity of AD also increased with time post SCI during both procedures. Considering the high incidence of silent episodes of AD during the urological procedures, it is recommended that monitoring of cardiovascular parameters during these procedures be routinely performed. One of the most common physician-induced causes of AD in individuals with SCI is the use of procedures that involve urinary bladder and urogenital areas. 3 Previously, numerous studies using different groups of individuals with SCI examined CV responses either during urodynamic 3-6 or cystoscopic examination. 7,8 These two procedures both involve urinary bladder distension. However, cystoscopy includes greater stimulation of the urethra and bladder neck afferents during the procedure through urethral/prostate/ internal sphincter passage and dilation, which could then provide more intense afferent stimulation to the spinal cord and trigger more pronounced episodes of AD. Considering the physiological difference

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“…During standard urodynamic examinations, it has been reported that 43% of patients with lesions at or above T6 and 15% of patients with lesions below have AD. 15 In a retrospective study of 571 Japanese patients with high SCI, symptomatic AD was mainly associated with use of reflex voiding and manual removal of stool. 16 In contrast, subjects who were continent on spontaneous voiding and defecation had the lowest prevalence of AD.…”

Section: Discussionmentioning

confidence: 99%

Autonomic dysreflexia during bowel evacuation procedures and bladder filling in subjects with spinal cord injury

et al. 2014

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Study design: Randomized, controlled clinical trial. Objectives: Bladder and bowel management may cause serious autonomic dysreflexia (AD) in subjects with high spinal cord injury (SCI). We aimed at investigating autonomic responses to digital rectal evacuation (DE), transanal irrigation (TAI) with 500 ml and filling cystometry (FC) in SCI. Setting: Aarhus University Hospital, Denmark. Methods: Eight subjects with SCI (AIS A) at or above T6 (high SCI) and a previous history of AD were compared with three subjects with SCI (AIS A) between T10 and L2 (low SCI). In randomized order, DE, TAI and FC were performed. AD was defined as an acute rise in systolic blood pressure (sBP) of X30 mm Hg above baseline. Blood levels of norepinephrine and epinephrine were determined before and shortly after the procedures. Results: During all three procedures, AD occurred in all patients with high SCI but not in those with low SCI. In high SCI subjects, DE increased median sBP from 127 (range: 86-154) to 188 (range: 140-206) mm Hg (Po0.02), TAI from 126 (range: 91-146) to 163 (range: 130-188) mm Hg (Po0.02) and FC from 125 (range: 106-149) to 200 (range: 179-220) mm Hg (Po0.01). The sBP increase was lower during TAI than during DE (Po0.05) or FC (Po0.02). In high SCI subjects, the blood levels of norepinephrine, but not those of epinephrine, increased significantly during all three stimuli (all Po0.05). Conclusion: Bowel and bladder management caused AD in high SCI. The response is less severe during TAI than during FC or DE.

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Autonomic Dysreflexia During Urodynamic Examinations in Patients With Suprasacral Spinal Cord Injury

Cited by 39 publications

References 23 publications

Blood pressure and age associated with silent autonomic dysreflexia during urodynamic examinations in patients with spinal cord injury

Blood pressure and age associated with silent autonomic dysreflexia during urodynamic examinations in patients with spinal cord injury

Autonomic dysreflexia severity during urodynamics and cystoscopy in individuals with spinal cord injury

Autonomic dysreflexia during bowel evacuation procedures and bladder filling in subjects with spinal cord injury

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