Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Anesthesia for adults with chronic spinal cord injury

Lorri A Lee, MD
Letha Mathews, MBBS, FFARCS (I)
Section Editor
Jeffrey J Pasternak, MD
Deputy Editor
Marianna Crowley, MD


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".)


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Sep 2016. | This topic last updated: Oct 11, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
  1. Myers J, Lee M, Kiratli J. Cardiovascular disease in spinal cord injury: an overview of prevalence, risk, evaluation, and management. Am J Phys Med Rehabil 2007; 86:142.
  2. McKinley WO, Gittler MS, Kirshblum SC, et al. Spinal cord injury medicine. 2. Medical complications after spinal cord injury: Identification and management. Arch Phys Med Rehabil 2002; 83:S58.
  3. Perkash A, Brown M. Anemia in patients with traumatic spinal cord injury. J Am Paraplegia Soc 1986; 9:10.
  4. Yoo K, Hwang J, Jeong S, et al. Anesthetic requirements and stress hormone responses in spinal cord-injured patients undergoing surgery below the level of injury. Anesth Analg 2006; 102:1223.
  5. Khan S, Plummer M, Martinez-Arizala A, Banovac K. Hypothermia in patients with chronic spinal cord injury. J Spinal Cord Med 2007; 30:27.
  6. Schmidt KD, Chan CW. Thermoregulation and fever in normal persons and in those with spinal cord injuries. Mayo Clin Proc 1992; 67:469.
  7. Jackson AB, Groomes TE. Incidence of respiratory complications following spinal cord injury. Arch Phys Med Rehabil 1994; 75:270.
  8. Cotton BA, Pryor JP, Chinwalla I, et al. Respiratory complications and mortality risk associated with thoracic spine injury. J Trauma 2005; 59:1400.
  9. Stepp EL, Brown R, Tun CG, et al. Determinants of lung volumes in chronic spinal cord injury. Arch Phys Med Rehabil 2008; 89:1499.
  10. Dalal K, DiMarco AF. Diaphragmatic pacing in spinal cord injury. Phys Med Rehabil Clin N Am 2014; 25:619.
  11. Burchiel KJ, Hsu FP. Pain and spasticity after spinal cord injury: mechanisms and treatment. Spine (Phila Pa 1976) 2001; 26:S146.
  12. Siddall PJ, Loeser JD. Pain following spinal cord injury. Spinal Cord 2001; 39:63.
  13. Houtman S, Oeseburg B, Hopman MT. Blood volume and hemoglobin after spinal cord injury. Am J Phys Med Rehabil 2000; 79:260.
  14. Yoo KY, Jeong CW, Kim SJ, et al. Cardiovascular and arousal responses to laryngoscopy and tracheal intubation in patients with complete spinal cord injury. Br J Anaesth 2009; 102:69.
  15. Martyn JA, Richtsfeld M. Succinylcholine-induced hyperkalemia in acquired pathologic states: etiologic factors and molecular mechanisms. Anesthesiology 2006; 104:158.
  16. Stone WA, Beach TP, Hamelberg W. Succinylcholine-induced hyperkalemia in dogs with transected sciatic nerves or spinal cords. Anesthesiology 1970; 32:515.
  17. Tobey RE. Paraplegia, succinylcholine and cardiac arrest. Anesthesiology 1970; 32:359.
  18. Carter JG, Sokoll MD, Gergis SD. Effect of spinal cord transection on neuromuscular function in the rat. Anesthesiology 1981; 55:542.
  19. John DA, Tobey RE, Homer LD, Rice CL. Onset of succinylcholine-induced hyperkalemia following denervation. Anesthesiology 1976; 45:294.
  20. Barker I, Alderson J, Lydon M, Franks CI. Cardiovascular effects of spinal subarachnoid anaesthesia. A study in patients with chronic spinal cord injuries. Anaesthesia 1985; 40:533.
  21. Schonwald G, Fish KJ, Perkash I. Cardiovascular complications during anesthesia in chronic spinal cord injured patients. Anesthesiology 1981; 55:550.
  22. Kirshblum S, Millis S, McKinley W, Tulsky D. Late neurologic recovery after traumatic spinal cord injury. Arch Phys Med Rehabil 2004; 85:1811.
  23. Vadhera RB, Pacheco LD, Hankins GD. Acute antihypertensive therapy in pregnancy-induced hypertension: is nicardipine the answer? Am J Perinatol 2009; 26:495.
  24. Maehama T, Izena H, Kanazawa K. Management of autonomic hyperreflexia with magnesium sulfate during labor in a woman with spinal cord injury. Am J Obstet Gynecol 2000; 183:492.