Autonomic dysreflexia in spinal cord injury

Cowan, Helen; Lakra, Celine; Desai, Manish

doi:10.1136/bmj.m3596

Cited by 49 publications

(39 citation statements)

References 5 publications

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“…The pathophysiological changes of SCI make anesthesia management more complicated during cesarean sections in a parturient with paraplegia, and AHR triggered by noxious and distension stimuli below the level of the injury during childbirth is the most severe life-threatening complication ( 3 ). As a result of uterine contractions, any parturient with SCI whose injury is at T6 or above is at a risk of acute AHR, which is usually mistaken for preeclampsia at onset ( 4 ).…”

Section: Discussionmentioning

confidence: 99%

Case Report: Anesthetic Management of Cesarean Section in a Patient With Paraplegia

Su¹,

Lei²,

Yu³

2022

Front. Med.

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BackgroundWith the advancement of medical science and rehabilitative care, more women with spinal cord injury (SCI) can conceive. However, autonomic hyperreflexia due to SCI complicates anesthesia management during cesarean sections.Case PresentationThis study reports the anesthesia management in a woman with paraplegia with a T6 SCI lesion who underwent a cesarean section. It also reviews the anesthesia strategies used in other studies. Spinal anesthesia with a low concentration of ropivacaine was administered along with dexmedetomidine for sedation. Stable hemodynamics were achieved without complications.ConclusionsBased on the reported case and literature review, we conclude that the intrathecal block is the preferred choice for women with paraplegia who require cesarean section if the lumbar bone structure allows puncture attempts.

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Section: Discussionmentioning

confidence: 99%

Case Report: Anesthetic Management of Cesarean Section in a Patient With Paraplegia

Su¹,

Lei²,

Yu³

2022

Front. Med.

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“… 29 Areas in which new recommendations were developed to reflect burgeoning science. also reflect the presence of local champions in Canada who are leading the development of innovations in SCI care including: hemodynamic monitoring, 30 early surgical spinal cord decompression, 31 upper limb rehabilitation including the selection of patient appropriate for tenodesis or peripheral nerve transplant surgery, 32 bone health, 33 autonomic dysreflexia, 34 respiratory care, 35 , 36 and sexual health. 37 …”

Section: Discussionmentioning

confidence: 99%

Development of the Canadian Spinal Cord Injury Best Practice (Can-SCIP) Guideline: Methods and overview

Patsakos

Bayley

Kua

et al. 2021

The Journal of Spinal Cord Medicine

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Introduction Spinal cord injury (SCI) is a life-altering injury that leads to a complex constellation of changes in an individual’s sensory, motor, and autonomic function which is largely determined by the level and severity of cord impairment. Available SCI-specific clinical practice guidelines (CPG) address specific impairments, health conditions or a segment of the care continuum, however, fail to address all the important clinical questions arising throughout an individual’s care journey. To address this gap, an interprofessional panel of experts in SCI convened to develop the Canadian Spinal Cord Injury Best Practice (Can-SCIP) Guideline. This article provides an overview of the methods underpinning the Can-SCIP Guideline process. Methods The Can-SCIP Guideline was developed using the Guidelines Adaptation Cycle. A comprehensive search for existing SCI-specific CPGs was conducted. The quality of eligible CPGs was evaluated using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. An expert panel ( n = 52) convened, and groups of relevant experts met to review and recommend adoption or refinement of existing recommendations or develop new recommendations based on evidence from systematic reviews conducted by the Spinal Cord Injury Research Evidence (SCIRE) team. The expert panel voted to approve selected recommendations using an online survey tool. Results The Can-SCIP Guideline includes 585 total recommendations from 41 guidelines, 96 recommendations that pertain to the Components of the Ideal SCI Care System section, and 489 recommendations that pertain to the Management of Secondary Health Conditions section. Most recommendations ( n = 281, 48%) were adopted from existing guidelines without revision, 215 (36.8%) recommendations were revised for application in a Canadian context, and 89 recommendations (15.2%) were created de novo . Conclusion The Can-SCIP Guideline is the first living comprehensive guideline for adults with SCI in Canada across the care continuum.

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“…Spinal cord injury (SCI) refers to the damage of the spinal cord due to various pathogenic factors and is a common clinical disease in orthopedics [ 1 ]. SCI is a multi-stage, multi-pathway, and multi-factorial pathological process that often leads to severe neurological dysfunction [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Screening of disease-related biomarkers related to neuropathic pain (NP) after spinal cord injury (SCI)

Zhao

Huang

et al. 2021

Hum Genomics

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Background Based on the molecular expression level, this paper compares lncRNA and mRNA expressions respectively in peripheral blood samples of the patients after SCI with NP and without NP, and screens disease-related biomarkers related to NP after SCI in peripheral blood samples of patients. Method The expression spectrum of 25 human peripheral blood samples (12 samples of refractory NP patients after SCI) was downloaded and data were normalized. Screening of GO annotations significantly associated with significant differentially expressed mRNAs and significant involvement of the KEGG pathway. The WGCNA algorithm was used to screen for modules and RNAs that were significantly associated with disease characterization. A co-expression network was constructed to extract the genes involved in the disease pathway from the co-expression network, construct a network of SCI pain-related pathways, and screen important disease-related biomarkers. Quantitative real-time PCR was used to detect the mRNA expression of hub genes. Results Data were normalized and re-annotated by detection of platform information, resulting in a total of 289 lncRNA and 18197 mRNAs. Screening resulted in 338 significant differentially expressed RNAs that met the threshold requirements. Differentially expressed RNAs were significantly enriched with the brown and magenta modules. Six KEGG signaling pathways were screened in the co-expression network, and three KEGG pathways with direct neuropathic pain were identified. The expression levels of E2F1, MAX, MITF, CTNNA1, and ADORA2B in the disease group were all significantly upregulated (p < 0.01). Compared with the normal group, the expression of OXTR was upregulated. Conclusion We speculate that there are 7 genes and 2 lncRNAs directly involved in the pain pathway: E2F1, MAX, MITF, CTNNA1, ADORA2B, GRIK3, OXTR, LINC01119, and LINC02447. These molecules may be important for NP after SCI.

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Autonomic dysreflexia in spinal cord injury

Cited by 49 publications

References 5 publications

Case Report: Anesthetic Management of Cesarean Section in a Patient With Paraplegia

Case Report: Anesthetic Management of Cesarean Section in a Patient With Paraplegia

Development of the Canadian Spinal Cord Injury Best Practice (Can-SCIP) Guideline: Methods and overview

Screening of disease-related biomarkers related to neuropathic pain (NP) after spinal cord injury (SCI)

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