Autonomic dysreflexia in a parturient with spinal cord injury.
Autonomic dysreflexia (ADR) is a syndrome of imbalanced reflex sympathetic discharge occurring in patients with spinal cord injury (SCI) at or above the level of splanchnic sympathetic outflow (T6). We present the case of a 29 year-old, gravida 3, para 1 Caucasian female at 28 weeks gestation, with a history of T3 SCI secondary to a gunshot wound 9 years prior, who developed ADR during preterm labor and received epidural anesthesia during 6 days of labor followed by spinal anesthesia for cesarean section. Spinal anesthesia may be superior to epidural anesthesia for providing hemodynamic protection against ADR during cesarean section.
Osgood
S L
SL
Department of Anesthesiology, University of California San Diego, San Diego, California 92103-8770, USA.
Kuczkowski
K M
KM
D000328:Adult; D000767:Anesthesia, Epidural; D000773:Anesthesia, Obstetrical; D000775:Anesthesia, Spinal; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage; D020211:Autonomic Dysreflexia / Q000209:etiology* / Q000517:prevention & control; D002045:Bupivacaine / Q000008:administration & dosage; D002585:Cesarean Section; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000517:prevention & control; D007752:Obstetric Labor, Premature / Q000517:prevention & control; D011247:Pregnancy; D011248:Pregnancy Complications; D013119:Spinal Cord Injuries / Q000150:complications*; D013904:Thoracic Vertebrae; D014948:Wounds, Gunshot
D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D005283:Fentanyl; D002045:Bupivacaine