AA

Prevention of AD during General Surgery

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Despite the partial or total loss of sensation below the level of injury, surgical procedures or manipulations can potentially initiate episodes of AD.  Anesthesiologists and surgeons performing surgery on SCI patients must be aware of the interactions of the anesthetic and its effects on AD and how to prevent or manage AD during these procedures.

Table 10: Prevention of AD during Surgery

Two observational studies (Lambert et al. 1982; Eltorai et al. 1997) presented evidence that AD is a common complication during general surgery in individuals with SCI.  Up to 90% of individuals undergoing surgery with topical anesthesia or no anesthesia developed AD.  Both studies concluded that patients at risk for AD could be protected by either general or spinal anesthesia.

Discussion

Two observational studies (Lambert et al. 1982; Eltorai et al. 1997) presented evidence that AD is a common complication during general surgery in individuals with SCI.  Up to 90% of individuals undergoing surgery with topical anesthesia or no anesthesia developed AD.  Both studies concluded that patients at risk for AD could be protected by either general or spinal anesthesia.

Conclusion

There is level 5 evidence (from 2 observational studies) (Lambert et al. 1982; Eltorai et al. 1997) that indicates that patients at risk for autonomic dysreflexia are protected from developing intraoperative hypertension by either general or spinal anesthesia.

  • Anesthesiologists and surgeons dealing with SCI patients must know how to recognize the AD syndrome, how to prevent its occurrence and how to manage it.

    Anesthesia should be used during surgical procedures in individuals with SCI despite apparent lack of sensation.