[Anesthetic management for urological surgery of patients with chronic spinal cord injury].
We evaluated retrospectively the anesthetic management and perioperative complications of 47 patients with chronic spinal cord injury for genitourinary procedures. Of the 69 cases, 38 were performed under general anesthesia, 21 cases under spinal anesthesia, one case under epidural anesthesia, four cases under axillary block, and five cases under either sedation or standby. In preoperative laboratory findings, anemia was observed in 41%, hypoproteinemia in 38%, renal insufficiency in 23%, and restrictive pulmonary dysfunction in 69%. Hypotension and bradycardia were seen in 25% and 16% of patients, respectively. Autonomic hyperreflexia was seen in four cases with cervical cord injury: two under spinal anesthesia and two under either sedation or standby. Patients with chronic spinal cord injury have disorders of various organ systems. Careful preoperative evaluation and anesthetic management are required for prevention and prompt treatment of perioperative complications related to the disorders. Autonomic hyperreflexia can be successfully prevented by either general anesthesia or spinal anesthesia. The increased anesthesia safety can be obtained by the successful management of the cardiovascular instability during surgery.
Okuyama
A
A
Department of Anesthesiology, Hokkaido University School of Medicine, Sapporo.
Ueda
M
M
Morimoto
Y
Y
Okuyama
M
M
Kemmotsu
O
O
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000758:Anesthesia / Q000379:methods*; D001342:Autonomic Nervous System Diseases / Q000517:prevention & control; D002648:Child; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D012021:Reflex, Abnormal; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000150:complications*; D014570:Urologic Diseases / Q000601:surgery*