EPIDURAL ANALGESIA AND PREVENTION OF AUTO NOMIC HYPERREFLEXIA IN A PARAPLEGIC PARTURIENT

Pregnancy In a patient suffering from high spinal cord lesions is unus ual and can lead to serious autonomic hyperreflexia during delivery. E pidural anaesthesia has been suggested as a means of decreasing such a risk. This clinical report presents the case of a paraplegic patient with lesions above the T3 level who had spinal anaesthesia for a Caesa rean section. Her first delivery, six. years earlier and without spina l anaesthesia was complicated by serious autonomic hyperreflexia with severe hypertension, seizures and inhalation.These symptoms were at fi rst interpreted as eclampsia. For the Caesarean section, spinal anaest hesia using 0.25 % bupivacaine in divided doses presented no difficult y, in spite of important lordosis, and permitted the delivery of a new born with an Apgar score of 10 at one minute. The upper sympathetic le vel reached (T4-T6) was assessed by the discontinuing of muscular spas ticity and contractures elicited by cutaneous stimuli. At the present time, spinal anaesthesia is the best method for preventing autonomic h yperreflexia. General anaesthesia, especially with halothane, is effec tive, but requires a deeper anaesthesia with the risk of serious hypot ension and its possible repercussions on the fetus. Moreover it does n ot decrease the risk of autonomic hyperreflexia during the postoperati ve period.