Anesthesia for adults with chronic spinal cord injury
- Lorri A Lee, MD
Lorri A Lee, MD
- Professor of Anesthesiology and Neurological Surgery
- Vanderbilt University Medical Center
- Letha Mathews, MBBS, FFARCS (I)
Letha Mathews, MBBS, FFARCS (I)
- Associate Professor of Clinical Anesthesiology
- Vanderbilt University Medical Center
Spinal cord injury (SCI) produces a wide variety of changes in systemic physiology that can lead to complications over time. Patients with chronic spinal cord dysfunction often require anesthesia for urologic, orthopedic, and plastic surgical procedures.
For the purpose of this discussion, chronic injury will be defined as the condition beyond several weeks after injury.
This topic discusses the anesthetic management of patients with chronic SCI. Anesthesia for patients with acute SCI and the chronic complications of patients with SCI are discussed separately. (See "Anesthesia for adults with acute spinal cord injury" and "Chronic complications of spinal cord injury and disease".)
A medical history and anesthesia-directed physical examination should be performed for all patients who undergo anesthesia. For these patients, we focus the evaluation on the diverse systemic complications that can occur with chronic spinal cord injury (SCI) and that can affect anesthetic management.
Chronic complications of SCI of particular concern for anesthesia are discussed here; other complications are discussed more fully separately. (See "Chronic complications of spinal cord injury and disease".)
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- PREOPERATIVE EVALUATION
- Cardiovascular complications
- - Autonomic dysreflexia
- - Coronary artery disease
- - Others
- Pulmonary complications
- Musculoskeletal complications
- Pressure ulcers
- Chronic pain
- Airway evaluation
- ANESTHESIA MANAGEMENT
- Choice of anesthetic technique
- General anesthesia
- - Induction of anesthesia
- Induction agents
- Neuromuscular blocking agents
- - Airway management
- - Maintenance of anesthesia
- - Emergence from anesthesia
- Regional anesthesia
- Positioning for surgery
- Hemodynamic management
- Management of intraoperative autonomic dysreflexia
- Temperature control
- POSTOPERATIVE CARE
- ANALGESIA FOR LABOR AND DELIVERY
- SUMMARY AND RECOMMENDATIONS