Increasing numbers of patients with spinal cord injury present for sur
gery or obstetric care. Spinal cord injury causes unique pathophysiolo
gical changes. The most important peri-operative dangers are autonomic
dysreflexia, bradycardia, hypotension, respiratory inadequacy and mus
cle 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 p
atient in this situation. General anaesthesia of sufficient depth is e
ffective at controlling spasms and autonomic dysreflexia but hypotensi
on 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 consecut
ive anaesthetics in cord-injured patients and a review of the current
literature on anaesthesia for patients with chronic spinal cord lesion
s.