Articles  |   October 2019
ACE Question
Article Information
Central and Peripheral Nervous Systems / Education / CPD / Articles
Articles   |   October 2019
ACE Question
ASA Monitor 10 2019, Vol.83, 30-31.
ASA Monitor 10 2019, Vol.83, 30-31.
A 35-year-old woman with a T4 spinal cord injury is undergoing colorectal surgery. Which of the following signs would most likely indicate intraoperative autonomic dysreflexia in this patient?
Autonomic dysreflexia (also called autonomic hyperreflexia) can be seen in patients with a spinal cord injury at T6 or above. It is estimated that two-thirds of patients with this level of spinal cord injury are at risk for autonomic dysreflexia (AD).
Unopposed sympathetic efferent outflow is triggered by noxious afferent input (such as pain) from below the level of the spinal cord injury, which results in the signs and symptoms of AD (Figure 1). In a patient without spinal cord injury, an inhibitory signal (traveling through the intact spinal cord) would occur in response to this, preventing AD. This pathway is blocked in spinal cord injury.
1 Comment
October 13, 2019
Rakki Elangovan
Columbia St. Mary's Hospital Milwaukee
Autonomic dysreflexia during surgery below spinal cord injury at T4
If this happens, I would not increase the inhalation agent because that might put him/her into pulmonary edema. Because of acute increase in after load. I would use a large dose of narcotic like sufenta and propofol bolus small does. Then use a vasodilator - I like Cleviprex I.V. drip.
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