AUTONOMIC HYPERREFLEXIA IN A PREGNANT PARAPLEGIC PATIENT - CASE-REPORT

Background and Objectives. Pregnant patients with spinal cord injuries are predisposed to autonomic hyperreflexia, which if unrecognized or untreated can lead to death. Hypertension occurring in laboring patien ts at risk for autonomic hyperreflexia must be managed aggressively. M ethods. Epidural anesthesia can safely control autonomic hyperreflexia during labor and delivery, but because spinal cord impaired patients lack sensory and motor function below the level of injury, it is diffi cult to determine the dermatomal spread of epidural anesthesia by the usual methods. This difficulty is highlighted by the following case, r eporting an epidural that failed during labor, with the subsequent dev elopment of autonomic hyperreflexia. Results. Previously, autonomic hy perreflexia occurring in pregnant patients (undergoing surgical proced ures) was treated with intravenous antihypertensive agents. During lab or, however, titrating these agents to coincide with uterine contracti ons is difficult. In this case, epidural anesthesia was repeated and t he autonomic hyperreflexia resolved. Conclusions. Autonomic hyperrefle xia can develop in unanesthetized laboring paraplegic patients (failed epidural) but it can be successfully managed with adequate epidural a nesthesia.