Low Spinal Anesthesia for the Prevention of Autonomic Dysreflexia in the Spinal Cord Injury Patient

Broecker, Bruce H.; Hranowsky, Nicholas; Hackler, Robert H.

doi:10.1016/s0022-5347(17)56409-5

Cited by 19 publications

(4 citation statements)

References 5 publications

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“…Broekner . [69] reported 25 successful cases using 25–50 mg of hyperbaric 5% lignocaine. Technical difficulties may occur, as a result of kyphoscoliosis, previous spinal surgery, inability to flex the spine due to spasms and bony deformities [62, 70], though these problems may have been overemphasized [62].…”

Section: Anaesthesiamentioning

confidence: 99%

“…The use of epidural anaesthesia is widely reported as being less satisfactory. An adequate epidural block should theoretically be as effective as spinal anaesthesia in preventing autonomic dysreflexia but numerous failures have been reported [62, 69, 71]. Failure to block sacral segments and missed segments resulting from distortion of the epidural space are the most likely explanations, together with an inability to assess the block accurately.…”

Section: Anaesthesiamentioning

confidence: 99%

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Anaesthesia for chronic spinal cord lesions

1998

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SummaryIncreasing numbers of patients with spinal cord injury present for surgery or obstetric care. Spinal cord injury causes unique pathophysiological changes. The most important peri-operative dangers are autonomic dysreflexia, bradycardia, hypotension, respiratory inadequacy and muscle spasms. Autonomic dysreflexia is suggested by headache, sweating, bradycardia and severe hypertension and may be precipitated by surgery, especially bladder distension. Patients with low, complete lesions, undergoing surgery below the level of injury, may safely do so without anaesthesia provided there is no history of autonomic dysreflexia or troublesome spasms. An anaesthetist should be present to monitor the patient in this situation. General anaesthesia of sufficient depth is effective at controlling spasms and autonomic dysreflexia but hypotension and respiratory dysfunction are risks. There is a growing consensus that spinal anaesthesia is safe, effective and technically simple to perform in this group of patients. We present a survey of 515 consecutive anaesthetics in cord-injured patients and a review of the current literature on anaesthesia for patients with chronic spinal cord lesions. Dramatic improvements in the care of spinal cord injury patients have been achieved over the last few decades [1]. The active management of urinary tract and respiratory complications has lead to a decrease in mortality from renal and respiratory failure. Overall mortality decreased from over 80% at the time of World War I to less than 2% by the early 1980s. The implications of increased survival are an increase in the prevalence of spinal cord injuries, an increase in the numbers of patients presenting for elective surgery and an ever increasing number of spinal cord injured patients who develop further medical conditions as the result of normal ageing.Although the majority of spinal cord injured patients currently undergo elective surgery in specialised spinal units, the appearance of such patients on operating lists of other hospitals is likely to increase. Anaesthesia in the cord-injured patient poses unique difficulties. An understanding of the relevant pathophysiology assists in the provision of safe peri-operative care.

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Section: Anaesthesiamentioning

confidence: 99%

Section: Anaesthesiamentioning

confidence: 99%

Anaesthesia for chronic spinal cord lesions

1998

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“…Signs and symptoms of autonomic dysreflexia include hypertension, bradycardia or tachycardia, convulsions, cerebral hemorrhage, pulmonary edema, or even death. [16][17][18][19][20][21][22][23] Autonomic dysreflexia can occur from a full bladder, distended bowel, labor, or surgical procedure or manipulation without adequate anesthesia. Severe hypertension results from the massive sympathetic discharge.…”

Section: Autonomic Dysreflexiamentioning

confidence: 99%

Perioperative Care of the Pediatric Patient with a Spinal Cord Injury

Drum

2000

Topics in Spinal Cord Injury Rehabilitation

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“…Spinal anesthesia (SA) is an effective anesthetic method that can prevent autonomic dysreflexia and spasticity by blocking afferent nerve impulses [1, 2]. It has been pointed out, however, that it may be impossible to determine the level of the block in SCI patients [1].…”

Section: Introductionmentioning

confidence: 99%

Clinical trial of a method for confirming the effects of spinal anesthesia in patients with spinal cord injury

Takatsuki

Ohtsuka

2012

J Anesth

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In this case series study, we prospectively examined whether it might be possible to check the effect of spinal anesthesia (SA), based on the disappearance of lower extremity reflexes and spasticity, in patients with spinal cord injury (SCI), in whom the effect cannot be confirmed by the pinprick test or by using the Bromage scale. In 40 patients with chronic, clinically complete cervical SCI who were scheduled to receive SA, pre-anesthetic examination revealed that the Babinski sign, patellar tendon reflex, and spasticity (assessed using the Ashworth scale) were all positive in 31 patients, while two of these three pre-anesthetic assessment parameters were positive in eight patients. The effect of SA in these 39 patients (97.5 %) was confirmed by demonstrating the absence of both the Babinski sign and patellar tendon reflex and loss of spasticity after SA. Our results suggested that the effect of SA can be confirmed by the disappearance of the Babinski sign and patellar tendon reflex and loss of spasticity in most patients with complete cervical SCI, although determination of the level of the block is difficult. In conclusion, loss of the Babinski sign, patellar tendon reflex, and spasticity might be useful for checking the effect of SA in cervical SCI patients.

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Low Spinal Anesthesia for the Prevention of Autonomic Dysreflexia in the Spinal Cord Injury Patient

Abstract: Twenty-five patients with traumatic spinal cord injuries above T7 have been managed with low spinal anesthesia during endoscopic urologic procedures. The technique has been completely successful in preventing autonomic dysreflexia and has not been associated with hypotension.

Cited by 19 publications

References 5 publications

Anaesthesia for chronic spinal cord lesions

Anaesthesia for chronic spinal cord lesions

Perioperative Care of the Pediatric Patient with a Spinal Cord Injury

Clinical trial of a method for confirming the effects of spinal anesthesia in patients with spinal cord injury

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