- Pre-anesthetic Considerations:
- in spine injured patients, anesthesia is necessary even if the extremity is
insensate inorder to prevent spasm and
automatic dysreflexia;
- need to monitor for automatic dysreflexia (spinal anesthesia preferred);
- be aware that acture high paraplegics, because of generalized venous dilation,
may require larger than usual volumes of fluids to maintain adequate blood pressure;
- consider
Swan Ganz monitoring;
- be aware that chronic SCI pts have low intravascular volumes and are
usually sensitive to further losses of volume;
- wrap the lower extremity to prevent blood loss;
- protect pts in the prone position with bilateral rolls from increased
- Technical Pearls:
- carry out awake, fiberoptic intubation w/o moving neck;
- No Sellick Maneuver !
- although use of succinylcholine is contraindicated several days after
denervation injury, there is no evidence of muscle membrane
instability in the first few hours;
- Post Op Considerations:
- 5% of myelopathic patients who undergo anterior C-spine surgery will require
re-intubation;
- risk is increased by surgery on multiple levels;
- risk is decreased by fibro-optic intubation and by keeping the head
of the bed elevated to 30-40 deg postoperative (to reduce edema);
