Conceitos, manifestações clínicas e cuidados imediatos na disreflexia autonômica / Concepts, clinical manifestations, and immediate care in autonomical disreflexia / Conceptos, manifestaciones clínicas y cuidados inmediatos en la disreflexia autonómica

Objetivo: revisar a literatura a respeito da disreflexia autonômica e apresentar conceitos, manifestações clínicas e cuidados imediatos diante dessa síndrome. Método: revisão integrativa da literatura realizada no período de maio a junho de 2018. Para a busca de dados foram utilizadas as bases de dados SciELO, PubMed e Medline. Resultados: foram selecionados quinze artigos publicados no período de 2013-2018, em português, espanhol e inglês, que contemplaram em seus títulos e/ou resumos/conteúdo o termo disreflexia autonômica e/ou reabilitação e/ou traumatismo da medula espinal e/ou seus respectivos unitermos, disponibilizados na íntegra. Quanto ao ano de publicação, observou-se que 33,33% dos artigos selecionados foram publicados em 2017; em relação ao idioma de publicação, a língua inglesa predomina em 73,33% deles; no que tange ao canal de publicação, a revista The Journal of Spinal Cord Medicine apresenta 20% dos artigos escolhidos. Quanto às abordagens dos estudos, verificou-se a determinação de conceitos, manifestações clínicas e cuidados imediatos como temáticas mais apresentadas. Conclusão: foi possível observar que a disreflexia autonômica é uma síndrome de grandes limitações, fatores etiológicos e necessidades de cuidados especializados. Vale mencionar que há uma grande escassez de estudos sobre o tema.(AU)

Objective: to review the literature on autonomic dysreflexia and to present concepts, clinical manifestations and immediate care before this syndrome. Method: it is an integrative literature review, performed in the period from may to june 2018. Data search was performed using the SciELO, PubMed and Medline databases. Results: fifteen articles published in the period of 2013-2018 in Portuguese, Spanish and English were selected, which included in their titles and/or abstracts/contents the term autonomic dysreflexia and/or rehabilitation and/or spinal cord injuries and/ or their respective uniterms, available in full. As for the year of publication, it was observed that 33.33% of the articles selected were published in 2017; in relation to the language of publication, the English language predominates in 73.33% of them; with regard to the publication channel, The Journal of Spinal Cord Medicine presents 20% of the articles chosen. Regarding the approaches of the studies, the determination of concepts, clinical manifestations and immediate care were the most presented themes verified. Conclusion: it was possible to observe that autonomic dysreflexia is a syndrome of major limitations, etiological factors and specialized care needs. It is worth mentioning that there is a great shortage of studies on the subject.(AU)

Objetivo: Revisar la literatura acerca de la disreflexia autonómica y presentar conceptos, manifestaciones clínicas y cuidados inmediatos ante este síndrome. Método: es una revisión integrativa de la literatura, realizada en el período de mayo a junio de 2018. Para la búsqueda de datos se utilizaron las bases de datos SciELO, PubMed y Medline. Resultados: fueron seleccionados quince artículos publicados en el periodo 2013-2018, en portugués, español e inglés, cuyos títulos y/o resúmenes/contenido presentaba el término disreflexia autonómica y/o rehabilitación y/o traumatismo de la médula espinal y/o sus respectivos unitermos, disponibles en su totalidad. Se verificó que con respecto al año de publicación hubo un contingente mayor de publicaciones en el año 2017 (33,33%), en lengua inglesa (73,33%), mientras que la revista donde la temática fue más abordada fue The Journal of Spinal Cord Medicine (20%). En cuanto a los enfoques de los estudios, se verificó la determinación de conceptos, manifestaciones clínicas y cuidados inmediatos como temáticas más presentadas. Conclusión: fue posible observar que la disreflexia autonómica es un síndrome de grandes limitaciones, factores etiológicos y necesidades de cuidados especializados. Vale mencionar que hay una gran escasez de estudios sobre el tema.(AU)

Patients with chronic high spinal cord injury can be safely treated with neuromuscular electrical stimulation: cardiovascular function is unaffected / Pacientes com lesão crônica alta da medula espinhal podem ser tratados de forma segura com estimulação elétrica neuromuscular: a função cardiovascular não é afetada

OBJECTIVE: To identify changes in blood pressure and heart rate in individuals with chronic paraplegia undergone neuromuscular electrical stimulation treatment. METHOD: Design: Observational prospective. Participants: Twenty individuals with chronic paraplegia (neurological level above T6) belonging to two different groups (G1 and G2) were submitted to an upper limb exercise test. G1 patients (n=13) had been treated with neuromuscular electrical stimulation (25Hz, pulses of 300µs, 100V) for 2 years or more, at least once a week; G2 patients (n=7) did not receive neuromuscular electrical stimulation treatment; G3 individuals (n=6) were healthy volunteers. Procedures: Arterial blood pressure and heart rate were measured during four phases of the exercise test: at initial rest, during warmup, during the exercise itself, and at rest after the exercise. RESULTS: Systolic and diastolic blood pressures showed no statistical difference between groups. In the comparison between exercise phases, regardless of the group, systolic pressure was significantly higher and diastolic pressure significantly lower at the end of the exercise itself, when compared to all other phases. Resting heart rate was significantly lower in healthy controls vs. G1 and G2, which were not significantly different between themselves. Exercise increased heart rate in all groups. CONCLUSION: This study showed that the groups are normotensive and homogeneous in their results; heart rate was higher in both paraplegic groups compared to healthy controls, but no difference was found between treated vs. untreated groups. Thus, neuromuscular electrical stimulation is a safe and effective way to treat individuals with chronic paraplegia.

OBJETIVO: Identificar mudanças na pressão arterial e frequência cardíaca em indivíduos com paraplegia crônica tratados com estimulação elétrica neuromuscular. MÉTODO: Estudo prospectivo observacional. Participantes: vinte indivíduos com paraplegia crônica (nível neurológico acima de T6) pertencentes a dois diferentes grupos (G1 e G2) foram submetidos a um teste de exercício de membros superiores. Os pacientes do G1 (n = 13) haviam sido tratados com estimulação elétrica neuromuscular (25 Hz, pulsos de 300 µs, 100 V) por 2 anos ou mais, pelo menos uma vez por semana; os pacientes do G2 (n = 7) não receberam o tratamento com estimulação elétrica neuromuscular; os indivíduos do G3 (n = 6) eram voluntários saudáveis. Procedimentos: A pressão sanguínea arterial e a frequência cardíaca foram medidas durante quatro fases do teste de exercício: no repouso inicial, durante o aquecimento, durante o exercício e no repouso após o exercício. RESULTADOS: As pressões arteriais sistólica e diastólica não apresentaram diferença estatística entre os grupos. Na comparação entre as fases do exercício, independentemente do grupo, a pressão sistólica foi significativamente maior e a pressão diastólica significativamente menor no final do exercício, em comparação com todas as outras fases. A frequência cardíaca em repouso foi significativamente menor em controles saudáveis ​​versus G1 e G2, que não foram significativamente diferentes entre eles mesmos. O exercício aumentou a frequência cardíaca em todos os grupos. CONCLUSÃO: Este estudo mostrou que os grupos são normotensos e homogêneos em seus resultados; a frequência cardíaca foi maior em ambos os grupos paraplégicos em comparação com controles saudáveis, mas nenhuma diferença foi encontrada entre os grupos tratados versus os não tratados. Assim, a estimulação elétrica neuromuscular é uma maneira segura e eficaz de tratar indivíduos com paraplegia crônica.

Effects of Simulation with Problem-based Learning on Care for Patients with Autonomic Dysreflexia / 재활간호학회지

PURPOSE: The purpose of this study was to investigate the effects on critical thinking, problem solving, communication, confidence in nursing performance and learning satisfaction after simulation with problem-based learning. METHODS: This study used a non-equivalent control group no-synchronized design. Forty junior baccalaureate nursing students were recruited conveniently and assigned to the experimental (n=20) or control (n=20) group using time difference. The experimental group participated in lecture and simulation with problem-based learning on care for patients with autonomic dysreflexia while the control group received lecture and traditional practices. RESULTS: The experimental group presented significant improvement in critical thinking (Z=−2.10, p=.036), problem solving (t=3.36, p=.002), communication (t=2.32, p=.026), confidence in nursing performance (Z=−2.20, p=.028) and learning satisfaction (Z=−3.42, p=.001) compared with the control group. CONCLUSION: The results of this study indicated that simulation with problem-based learning is effective in improving critical thinking, problem solving, communication, confidence in nursing performance and learning satisfaction for nursing students.

Factores fisiológicos y psicológicos que influyen en la rehabilitación de las personas con trauma raquimedular / Physiological and psychological factors in rehabilitation of persons with traumatic of spinal cord

Resumen La rehabilitación integral de las personas con trauma raquimedular requiere integrar lo físico, emocional y social, es necesario indagar como estos factores se interrelacionan y afectan su calidad de vida. El objetivo fue determinar la interrelación de los factores fisiológicos y psicológicos en la rehabilitación integral de las personas con trauma raquimedular a partir de la Teoría de los Síntomas Desagradables de Elizabeth Lenz. Estudio descriptivo transversal, con 51 personas. Las variables independientes fueron clasificación ASIA, nivel de la lesión y sexo; las variables dependientes los factores fisiológicos y psicológicos. Se aplico análisis univariado y la prueba t para identificar las diferencias estadísticamente significativas. La disrreflexia autonómica, las disfunciones vesicales e intestinales generan estados de depresión y expresión de ira especialmente en los hombres, es muy importante brindar soporte para el cuidado de estos factores durante la rehabilitación integral.

Abstract The comprehensive rehabilitation of people with spinal cord trauma takes into account the person as a whole being in the physical, emotional and social sense; therefore, it is necessary to investigate how these factors interact and affect their quality of life. The objective was determining the interrelation between the physiological and psychological factors on rehabilitation of people with spinal cord trauma from the theory of unpleasant symptoms Elizabeth Lenz. A transversal descriptive study, with 51 people. The independent variables were ASIA classification, the level of injury, and gender; the dependent variables were the physiological and psychological factors. A univariate analysis, the t- test was applied to identify statistically significant differences. The autonomic dysreflexia and both bladder as well as bowel dysfunction, are symptoms that generate states of depression and expression of anger, and are more evident in men. The support is required in the care of these factors during la integral rehabilitation.

Transverse myelitis preexisting in pregnancy: A case report / Philippine Journal of Obstetrics and Gynecology

Transverse myelitis is an acute inflammatory lesion of the spinal cord resulting in motor, sensory, and autonomic dysfunction. Pregnancy increases risk of complications depending on the level of the spinal cord lesion. Hence, a multidisciplinary approach is needed during prenatal period. This is a case of IB, a 32 year-old primigravid, a known case of Transverse Myelitis, initially seen at ten weeks age of gestation. Prenatal course was managed accordingly. She underwent primary cesarean section for arrest cervical dilatation at 39 weeks, with an unremarkable post-operative course. There is an increased risk of preventable complications such as recurrent urinary tract infections, anemia, development of decubitus ulcers, premature labor and delivery and autonomic dysreflexia. It is imperative that during the prenatal period, the patient be monitored closely and referred to specialists for further management of these simple to fatal complications.

Factors Related to the Occurrence of Urinary Tract Infection Following a Urodynamic Study in Patients With Spinal Cord Injury

OBJECTIVE: To analyze the factors related to urinary tract infection (UTI) occurrence after an urodynamic study (UDS) in patients with spinal cord injury (SCI). METHODS: We retrospectively investigated the medical records of 387 patients with SCI who underwent UDS with prophylactic antibiotic therapy between January 2012 and December 2012. Among them, 140 patients met the inclusion criteria and were divided into two groups, UTI and non-UTI. We statistically analyzed the following factors between the two groups: age, sex, level of injury, SCI duration, spinal cord independence measure, non-steroidal anti-inflammatory drug use, diabetes mellitus, the American Spinal Injury Association impairment scale (AIS), lower extremity spasticity, a history of UTI within the past 4 weeks prior to the UDS, symptoms and signs of neurogenic bladder, urination methods, symptoms during the UDS and UDS results. RESULTS: Among the 140 study participants, the UTI group comprised 12 patients and the non-UTI group comprised 128 patients. On univariate analysis, a history of UTI within the past 4 weeks prior to the UDS was significant and previous autonomic dysreflexia before the UDS showed a greater tendency to influence the UTI group. Multivariable logistic regression analysis using these two variables showed that the former variable was significantly associated with UTI and the latter variable was not significantly associated with UTI. CONCLUSION: In patients with SCI, a history of UTI within the past 4 weeks prior to the UDS was a risk factor for UTI after the UDS accompanied by prophylactic antibiotic therapy. Therefore, more careful pre-treatment should be considered when these patients undergo a UDS.

Acute Onset of Intracerebral Hemorrhage due to Autonomic Dysreflexia

Autonomic dysreflexia is a clinical emergency syndrome of uncontrolled sympathetic output that can occur in patients who have a history of spinal cord injury. Despite its frequency in spinal cord injury patients, central nervous system complications are very rare. We report a man with traumatic high level incomplete spinal cord injury who suffered hypertensive right thalamic hemorrhage secondary to an episode of autonomic dysreflexia. Prompt recognition and removal of the triggering factor, the suprapubic catheter obstruction which led to hypertensive attack, the patient had a favorable functional outcome after the resorption of the hematoma and effective rehabilitation programme.

High-resolution Anorectal Manometry for Autonomic Dysreflexia in a Patient With Incomplete Cervical Spinal Cord Injury

No abstract available.

Disreflexia autonômica e intervenções de enfermagem para pacientes com lesão medular / Autonomic dysreflexia and nursing interventions for patients with spinal cord injury / Disreflexia autonómica e intervenciones de enfermería para pacientes con lesión medular

O presente trabalho trata-se de estudo retrospectivo realizado em 2009 que objetivou identificar diagnósticos e intervenções de enfermagem para o cuidado de pacientes com lesão medular (LM). Os dados foram coletados de 465 prontuários de pacientes com LM em processo de reabilitação. Identificou-se o diagnóstico de enfermagem Risco para disreflexia autônomica em 271 (58,3%) prontuários, dos quais 80 pacientes desenvolveram disreflexia autônomica. Predominaram homens jovens, com idade média de 35,7 anos, sendo o trauma a principal causa da LM e o nível neurológico igual ou acima da sexta vértebra torácica. As intervenções de enfermagem foram organizadas em dois grupos, um voltado para a prevenção da disreflexia autonômica e outro, para seu tratamento. Desenvolveu-se um guia de intervenções para uso na prática clínica de enfermeiros reabilitadores e para inserção em sistemas de informação. Ressalta-se a importância da retirada do estímulo causador da disreflexia autonômica como terapêutica mais eficaz e como melhor intervenção na prática de enfermagem.

This retrospective study, performed in 2009, aimed to identify nursing diagnoses and interventions for the care of patients with spinal cord injury. Data were collected from the nursing records of 465 patients with SCI undergoing rehabilitation. The nursing diagnosis Risk for autonomic dysreflexia was identified in 271 clinical records (58, 3%). Approximately 80 patients developed autonomic dysreflexia, with a predominance in young men around 35.7 years old, who had experienced a trauma as the main cause of the injury. Their neurological injury level was at the sixth thoracic vertebra or above. Nursing interventions were arranged in two groups, one focused on prevention and the other on treatment. An intervention guide was developed and can be used by nurses in their clinical practice of rehabilitation and can be included into information systems. The removal of the stimulus which causes autonomic dysreflexia was identified as the most effective therapy and the best intervention.

Estudio retrospectivas realizado en 2009 objetivando identificar diagnósticos e intervenciones de enfermería para el cuidado del paciente con lesión medular (LM). Datos colectados de 465 historias clínicas de pacientes con LM en rehabilitación. Se identificó el diagnóstico de enfermería Riesgo para disreflexia autonómica en 271 (58,3%) historias clínicas; 80 de tales pacientes desarrollaron Disreflexia autonómica. Predominaron hombres jóvenes, media etaria de 35,7 años, constituyéndose el trauma como causa principal de LM y nivel neurológico igual o por sobre sexta vértebra torácica. Las intervenciones de enfermería se organizaron en dos grupos: uno orientado a prevención de la disreflexia autonómica y otro para su tratamiento. Se desarrolló una guía de intervenciones para uso en práctica clínica de enfermeros rehabilitadores y para incorporación a sistemas de información. Se destaca la importancia de retirar el estímulo que provoca la disreflexia autonómica como terapéutica más eficaz y como mejor intervención en la práctica de enfermería.

Hiper-hidrose em paciente com traumatismo raquimedular / Hyperhidrosis in patient with spinal trauma

A hiper-hidrose é uma condição caracterizada por excessiva sudorese, sobretudo das palmas das mãos e axilas. Pode ser primária ou secundária. A primária tem sido associada com a hiperatividade do sistema nervoso simpático. A hiper-hidrose pode ser tratada clinicamente ou por meio da simpatectomia. Paciente do sexo masculino, 28 anos, ajudante de obras. Vítima de agressão física por arma de fogo. Exame neurológico: desperto. Pupilas isocóricas e ECG 15. Paraplegia crural com nível sensitivo-motor T10. TC da coluna dorsal: fratura do corpo e lâminas de T8, com fragmentos metálicos no canal medular. Quatro meses após o trauma, procurou o ambulatório de Neurocirurgia para acompanhamento do quadro neurológico e referia que após dois meses do trauma apresentou hiper-hidrose axilar e palmar bilateral. Submetido a tratamento conservador, fisioterapia motora e respiratória. Encaminhado ao serviço de Psiquiatria, que referiu a hiper-hidrose como consequência de ansiedade, sendo prescrito antidepressivo tricíclico, mas sem melhora do quadro da hiper-hidrose. Foi encaminhado para tratamento com a dermatologia e a possibilidade de ser submetido à intervenção cirúrgica endoscópica. Até a presente data não retornou ao ambulatório de neurocirurgia. Dentre as complicações clínicas do TRM, a hiper-hidrose tem sido relatada em alguns casos. A produção de suor é afetada após o trauma por causa de uma alteração do sistema nervoso simpático. O tratamento com antidepressivos proporciona apenas alívio parcial e pode apresentar efeitos colaterais. A intervenção cirúrgica, embora passível de efeitos secundários, é um método minimamente invasivo e eficiente no tratamento da hiper-hidrose primária ou secundária.

Hyperhidrosis is a condition characterized by excessive sweating, especially of the hands palms and armpits. It may be primary or secondary. The primary has been associated with hyperactivity of the sympathetic nervous system. Hyperhidrosis can be treated medically or by sympathectomy. Patients, male patient, 28 years old, assistant works. Victim of physical assault by a firearm. Neurological exam: awake. Pupils isochoric and ECG 15. Crural paraplegia with sensory-motor level T10. CT of the spine: fracture of the blades and vertebral body T8, with metal fragments in the spinal canal. Four months after the trauma, came to the neurosurgery clinic for follow-up of the neurological status and stated that two months after the trauma had bilateral palmar and axillary hyperhidrosis. The patient underwent conservative treatment, physical and respiratory therapy. Referred to the Department of Psychiatry, where he was informed that the hyperhidrosis was a consequence of anxiety, and it was prescribed tricyclic antidepressant, but without hyperhidrosis cure. He was referred to dermatology for treatment and the possibility of undergoing surgery as the evolution of endoscopic. To date not returned to the clinic of neurosurgery. Among the clinical complications of SCI, hyperhidrosis has been reported in some cases. The production of sweat is affected after trauma due to a change in the sympathetic nervous system. Treatment with antidepressants provides only partial relief and can have side effects. Surgical intervention, although susceptible to side effects, is a minimally invasive and effective treatment of primary or secondary hyperhidrosis.

Gravidez em mulheres com trauma medular prévio / Pregnancy on women with previous medullary injury

No Brasil, há 130 mil indivíduos com trauma da medula espinhal e, a cada cinco pessoas vítimas de lesão traumática da medula, uma é mulher. Devido ao trauma da medula espinhal ser menos incidente entre mulheres, e por estas permanecerem férteis e capazes de levar uma gravidez a termo, a literatura tem ignorado grandemente seu estudo ? fato que não elimina as muitas alterações psicofisiológicas, bem como as alterações na sexualidade e outras dificuldades durante a gestação. Apesar disso, os poucos estudos existentes indicam que, nesse caso, o parto normal pode ser vantajoso em relação à cesariana. O objetivo do trabalho foi realizar uma revisão da literatura sobre o assunto, e assim colaborar com os profissionais da área da saúde quanto à atenção à gestante com trauma da medula espinhal

In Brazil, there are 130 thousand individuals with spinal cord injury, and one out of five injured people is a woman. Due to the lower incidence of spinal cord injury among women, and to the fact that they remain fertile and able to carry a pregnancy to term, the literature has largely ignored their study ? a fact which does not exclude the many psycho-physiological changes, as well as alterations in sexuality and other difficulties during pregnancy. Nevertheless, the few existing studies indicate that the normal birth may be advantageous when compared to the cesarean. The objective of the article is to conduct a review of the literature on the subject, and thus collaborate with health care professionals on the attention to pregnant women with spinal cord injury

Rehospitalization in Community Dwelling Individuals with Spinal Cord Injury

OBJECTIVE: To describe the frequency and reasons for rehospitalization in patients with spinal cord injury (SCI) living in the community. METHOD: A total 388 patients with SCI living in community participated in the nationwide questionnaire-based study. A self-administered questionnaire was used. RESULTS: Of the 459 patients originally enrolled, 388 completed questionnaires, yielding response rate of 84.5%. The reasons for rehospitalization were SCI related complications (71.7%), periodic health evaluation (44.7%), and other causes (28.3%). The most frequent SCI related complications for rehospitalization were urinary tract infections (45.2%), pressure sores (39.7%), fever (18.3%), pain (18.3%), and autonomic dysreflexia (7.6%). The number of rehospitalized cases due to SCI related complication including urinary tract infection was significantly higher in complete SCI. Rehospitalization due to pressures sore was more frequent in people with paraplegia, male and complete injuries. CONCLUSION: In our study, 71.7% of patients with SCI experienced rehospitalization for SCI related complication after initial hospitalization. Urinary tract infection and pressure sores were the most common SCI related complications for rehospitalization.

Three cases of delivery in pregnant women with spinal cord injury / 대한산부인과학회지

Effective rehabilitation and assisted reproductive technology may increase the number of women considering pregnancy who have spinal cord injuries. It is important that obstetricians caring for these patients are aware of the specific problems related to spinal cord injuries. Autonomic dysreflexia is the most significant medical complication found in women with spinal cord injuries, and precautions should be taken to avoid stimuli that can lead to this potentially fatal complication. Women with spinal cord injuries may give birth vaginally, but when cesarean delivery is indicated, adequate anesthesia is needed. We report three cases of delivery in patients with spinal cord injury.

Clinical features and risk factors for HIV encephalopathy in children.

A prospective cohort study was conducted to determine the incidence of progressive encephalopathy (PE) and its associated clinical manifestations amongst a cohort of HIV infected children attending the HIV/AIDS clinic of the Pediatric Institute, Kuala Lumpur Hospital, Malaysia. Neurological and neurobehavioral assessments were performed in 55 children with HIV over a 24-month study period. Parameters assessed were physical and neurological assessments, CD4 counts, CD4 percentages, RNA viral loads and an IQ assessment at four monthly intervals. PE was diagnosed when patient developed at least one of the definitive criteria for PE based on the Consensus of Pediatric Neurology/Psychology Working Group, AIDS Clinical Trial 1996. The incidence of encephalopathy was 18.2% (n = 10) in 2002. All the patients had hepatosplenomegaly, lymphadenopathy, abnormal deep tendon reflexes and five had impairment in brain growth. The CD4 counts and CD4 percentages were more likely to be associated with PE compared to the non-PE group.

Anesthetic Requirements in Chronic Cord-injured Patients Undergoing Surgery below the Level of Injury / 대한마취과학회지

BACKGROUND: We determined the effect of spinal cord injury (SCI) on sevoflurane requirements and stress hormone responses, and sevoflurane concentration to block autonomic hyperreflexia (AHR) in SCI patients. METHODS: In the first series, sevoflurane concentrations to maintain bispectral index score (BIS) at 40-50 and stress hormone response were examined in 27 SCI patients undergoing surgery below the level of injury.Fifteen patients without SCI served as control.Measurements included end-tidal sevoflurane concentrations (ET(SEVO)), systolic blood pressure (SBP), heart rate (HR), catecholamines, vasopressin, and cortisol concentrations.In the second series, sevoflurane concentration to block AHR was examined in 31 SCI patients undergoing transurethral litholapaxy.When a patient developed an episode of AHR, the target sevoflurane concentration was maintained for 10 min, and then the procedure was repeated.Each target concentration was determined by up-down method based on SBP. RESULTS: During surgery, SBP, HR, and BIS were comparable between SCI and control.However, ETSEVO was significantly smaller in the SCI than the control.Plasma concentrations of norepinephrine, epinephrine and cortisol were significantly lower in the SCI than the control.SBP rose by 67 +/- 31 mmHg, whereas HR fell by 13 +/- 8 bpm during the 1st trial in the SCI (P < 0.01).Hypertensive events were associated with increases of norepinephrine concentrations.ETSEVO required to prevent AHR were 3.12% in 50% of patients, 3.83% in 95% of patients. CONCLUSIONS: SCI reduces the anesthetic requirement by 39%, and decreases stress hormone responses during surgery below the level of injury.To prevent AHR in 95% of SCI patients undergoing litholapaxy, ETSEVO 3.83% may be required.

Case Report of Autonomic Dysreflexia in a Pressure Sore Patient

PURPOSE: Plastic surgeons are responsible for the management of spinal cord injury patients with upper and lower extremity reconstruction, pressure sore, and wounds. Derailment of autonomic nervous systems caused by injury to the spinal cord may result in fatal autonomic dysreflexia. Autonomic dysreflexia is a syndrome of massive imbalance of reflex sympathetic discharge occurring in patients with spinal cord lesion above the splanchnic outflow(T6). It is characterized by a sudden onset and severe increase in blood pressure and is potentially life threatening. The other classic symptoms are headache, chest pain, sweating, and bradycardia. In order to lower the blood pressure, it is important to remove the noxious stimulus for autonomic dysreflexia. If such symptoms last for more than 15 minutes despite conservative interventions, antihypertension drugs are recommended. METHODS: In this case study, we report an autonomic dysreflexia case that developed in a 45 year-old tetraplegia patient with sacral pressure sore. When he got bladder irrigation, his blood pressure went up very high and his mentality became stuporous. He was sent to ICU for his blood pressure and mental care. ICU care made his vital sign stabilized and his mentality alert. RESULTS: After the patient underwent proper treatment like inotropic agent, he was transferred to the general ward and his pressure sore on sacral area was coveraged with gluteus maximus myocutaneous advancement flap. CONCLUSION: If treatment is not effective, the patients have to undergo sudden, severe hypertension, which can cause stroke or death. To provide safe and effective care, plastic surgeons should be able to recognize and treat autonomic dysreflexia.

Epidural Analgesia in the Parturient with Spinal Cord Injury: A case report / 대한마취과학회지

Autonomic dysreflexia is a syndrome of uninhibited sympathetic spinal reflexes in response to stimuli below the level of injury in the patients with high spinal lesions. During labor, it can cause uteroplacental vasoconstriction resulting in fetal distress or devastating maternal complications including retinal hemorrhage, cerebrovascular accident and hypertensive encephalopathy. Neuraxial blockade has proven to be an effective method to attenuate or prevent it. We present a case detailing the use of epidural analgesia in managing the delivery of a quadriplegic parturient with a history of autonomic dysreflexia.

Desire to Void in Patients with Complete Spinal Cord Injury

OBJECTIVE: To classify complete spinal cord injury (SCI) patients based on the preservation of desire to void and to make clear the difference between each group METHOD: This study was performed retrospectively on 117 complete SCI patients with lesions above T11 who were referred to the urodynamic laboratory. Patients were classified according to the preservation of desire to void during conventional urodynamic study. The clinical and urodynamic characteristics of each group were analyzed. RESULTS: There were 37 patients (31.6%) with the preservation of desire to void. There were significantly lower compliance of bladder and longer duration from onset to examination in the sensory preservation group than the nonpreservation group (p<0.05). There were no significant difference in clinical features such as voiding method, the presence of autonomic dysreflexia between each group. CONCLUSION: The presence of desire to void was noted in 31.6% of complete SCI patients observed.

Effectiveness of Captopril for the Management of Autonomic Dysreflexia in Spinal Cord Injuries

OBJECTIVE: In this study, we evaluate the efficacy of captopril comparing with nifedipine for management of hypertensive urgencies in autonomic dysreflexia in patients with spinal cord injury (SCI). METHOD: Twenty-four patients with SCI above T6 were documented and treated with drug therapy in this study whose systolic blood pressure (SBP) was at or above 150 mmHg despite the use of nondrug management during an autonomic dysreflexia episode. They were divided into two groups; captopril group (n=12) and nifedipine group (n= 12). Captopril group was administered captopril 25 mg sublingually and nifedipine group was administered nifedipine 10 mg sublingually. Diastolic blood pressure(DBP), systolic blood pressure (SBP), heart rate and side effects were monitored after administration. RESULTS: Mean DBP and SBP at baseline and 15, 30, 60 minutes after captopril were significantly decreased (p<0.05). There were no significant side effects such as reactive hypotension. The administration of nifedipine also successfully reduced mean SBP and DBP after 15, 30, 60 minutes (p<0.05), but some side effects were reported such as reactive hypotension, tarchycardia and headache. CONCLUSION: For the management of hypertension in autonomic dysreflexia, captopril appears to be one of the safe and effective methods in patients with SCI.

Hiperreflexia autonômica em gestante tetraplégica: relato de caso / Autonomic hyperreflexia in tetraplegic pregnant patient: case report

JUSTIFICATIVA E OBJETIVOS: As complicações da gestante com lesäo medular incluem infecções urinárias, calculose renal, anemia, úlceras de decúbito, espasmos musculares, sepsis, hiperatividade uterina e a hiperreflexia autonômica. Durante a anestesia a hiperreflexia autonômica é a complicaçäo mais importante, que deve ser, antes de tudo, prevenida. Ela é freqüentemente desenvolvida em pacientes com transecçäo medular ao nível da quinta à sétima vértebra torácica, ou acima. Nosso relato tem com objetivo apresentar um caso de gestante tetraplégica, com lesäo ao nível da sexta vértebra cervical, que se submeteu à operaçäo cesariana sob anestesia peridural contínua com bupivacaína a 0,25 por cento sem vasoconstritor, associada ao fentanil. RELATO DO CASO: Paciente tetraplégica, primigesta à termo, idade gestacional de 39 semanas, branca, 22 anos, 63 kg, 168 cm de altura, estado físico ASA II, internada para ser submetida a cesariana eletiva. Relatava trauma raquimedular ao nível de C6 há 3 anos. Após hidrataçäo prévia com 1500 ml de soluçäo fisiológica, procedeu-se à anestesia peridural com punçäo mediana no espaço L3-L4 com a paciente em decúbito lateral, agulha Tuohy descartável calibre 17G e sem botäo anestésico prévio. Imediatamente após a introduçäo da agulha, observou-se contraçäo da musculatura paravertebral adjacente, aumento da pressäo arterial (PA = 158 x 72 mmHg) e aumento da freqüência cardíaca (FC = 90 bpm). No entanto, a paciente näo relatava dor. Retirou-se agulha e fez-se o botäo anestésico, dando-se seqüência ao bloqueio peridural, com injeçäo de 20 ml de bupivacaína a 0,25 por cento sem vasoconstritor associados a 100 æg de fentanil espinhal e passagem de cateter peridural em sentido cefálico (3 a 4 cm). A cirurgia transcorreu sem intercorrências, näo havendo necessidade de complementaçäo do bloqueio em nenhum momento. Houve dois episódios de hipotensäo arterial nas primeiras 24 horas do pós-operatório, tratados com infusäo de soluçäo de Ringer com lactato. O cateter peridural foi mantido por 48 horas. A alta hospitalar ocorreu após três dias de internaçäo. CONCLUSÕES: Para gestantes paraplégicas ou tetraplégicas a anestesia peridural contínua com baixa concentraçäo de anestésico local sem vasoconstritor associado ao fentanil é uma boa indicaçäo para conduçäo do parto normal instrumentado ou não,...