ANESTHESIA FOR CHRONIC SPINAL-CORD LESIONS

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.