Acute spinal cord transection

• commonly associated with cervical spine fracture
• extension or flexion of head on neck may lead to further spinal cord damage
• consider fiberoptic intubation
  • perhaps under local anesthesia in awake patient
  • with little or no movement of head or neck
  • but no definite evidence of increased neurologic morbidity with direct larynogoscpy in anesthetized patient
• succinylcholine may be OK in first 24 hours, but after that avoid succinylcholine
• patient may already be anesthetic in operative area
• absence of sympathetic nervous system activity below transection
  • hypotension, especially with position change or hemorrhage, or starting positive pressure ventilation
  • hypothermia (poikilothermia below transection)
• Spontaneous ventilation often inadequate
• high-dose corticosteroid (methylprednisolone) infusion may be indicated

Chronic paralysis and autonomic hyperreflexia (AH)

• AH leads to abrupt marked increase in blood pressure with associated bradycardia
• 85% of patients with lesions above T6 have AH
• pathophysiology
  1. cutaneous or visceral stimulation below transection (e.g., distension of bladder) leads to
  2. reflex sympathetic nervous system activity with vasoconstriction below level of transection
  3. vasodilatory impluses from CNS cannot reach area below level of transection
• prevention of AH
  • spinal anesthesia most effective
  • general or epidural anesthesia also OK
• treatment of AH may require nitroprusside infusion

CEA Aneurysm Tumor Apnea Cord References
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