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KMID : 0352120180330010061
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Journal of Kyung Hee University
2018 Volume.33 No. 1 p.61 ~ p.65
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Anesthetic Management of Autonomic Hyperreflexia in a Patient with Spinal Cord Injury - A Case Report -
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Ryu Seung-Ah
Lee Chan-Hee
Kang Chang-Hwa
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Abstract
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Autonomic hyperreflexia (AHR) is one of the clinical symptoms that may occur in patients with spinal cord injury in the fourth to sixth thoracic vertebrae. Sudden hypertension, bradycardia, headache and other symptoms may occur. If not properly treated, AHR can lead to arrhythmia, myocardial infarction, cerebral hemorrhage, etc., which can be life-threatening. In this case, the patient was a 57-year-old man with tetraplegia due to fracture of the cervical vertebrae 3-4, and underwent an abdominoperineal resection of rectum to remove rectal cancer. Regarding concerns of prolonged surgery and intermittently occurring high intensity stimuli that might induce AHR, we expected that the control of depth of general anesthesia will not be enough to prevent the occurrence of AHR. Therefore we performed epidural drug injection under general anesthesia and successfully inhibited the development of AHR during surgery. Additiionally, norepinephrine was injected from the beginning of surgery because of the concern of hypotension that might be caused by the interruption of efferent sympathetic nerves and the decrease of systemic vascular resistance due to vagus hyperactivity. As a result, blood pressure remained normal until the end of the operation, thus we submit a case repot.
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KEYWORD
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Autonomic hyperreflexia, Autonomic dys-reflexia epidural anesthesia, Spinal cord injury
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