Anesthetic considerations for patients with acute cervical spinal cord injury

Neural Regeneration Research, 2017 · DOI: 10.4103/1673-5374.202916 · Published: March 1, 2017

Spinal Cord Injury Anesthesiology Neurology

Simple Explanation

Anesthesiologists play a crucial role in preventing or minimizing secondary injury to the nervous system during medical procedures, particularly for patients with acute cervical spinal cord injuries (CSCI). They achieve this by having a deep understanding of the underlying disease processes and optimizing their skills and equipment to create a suitable anesthesia plan. During preoperative interviews, anesthesiologists should perform thorough physical examinations and consider neuroprotection strategies. During airway management, it is important to consider cervical spinal cord movement and compression, potentially suggesting awake fiberoptic bronchoscope intubation for stable patients or direct laryngoscopy with manual in-line immobilization in emergencies. During the induction phase, anesthesiologists should avoid hypotension and depolarizing muscle relaxants. Mean artery pressure should be maintained within a specific range (85–90 mmHg), and normal arterial carbon dioxide pressure and blood glucose levels should be ensured.

Study Duration

Not specified

Participants

Not specified

Evidence Level

Review

Key Findings

1
Maintaining mean arterial blood pressure (MAP) at 85 to 90 mmHg in the first week following injury can improve spinal perfusion.
2
Manual in-line immobilization (MILI) is recommended as an airway intervention standard in known or suspected cervical injury patients.
3
Between three days to nine months following CSCI, patients should avoid depolarizing muscle relaxants such as succinylcholine, as these can trigger fatal hyperkalemia.

Research Summary

Anesthesiologists must understand the pathophysiology of acute cervical spinal cord injuries (CSCI) to prevent secondary injury and improve patient outcomes. This includes careful preoperative assessment, airway management, induction, maintenance of anesthesia, and postoperative intensive care. Preoperative assessment involves determining the cause and timing of injury, conducting physical and neurological examinations, and radiographic assessment to evaluate the level of SCI and cervical spine stability. Optimal airway management aims to minimize neck movement while securing the airway. Techniques like manual in-line immobilization (MILI), video laryngoscopy, and awake fiberoptic bronchoscope intubation are considered.

Practical Implications

Enhanced Patient Safety

By adhering to these anesthetic considerations, the risk of secondary neurological damage during procedures can be significantly reduced, leading to better patient outcomes.

Improved Clinical Practice

Provides anesthesiologists with a detailed guide for managing patients with acute cervical spinal cord injuries, covering all phases of care.

Guidance for Future Research

Highlights the need for further research into neuroprotective and neuroregenerative solutions for CSCI, encouraging exploration of new therapeutic interventions.

Study Limitations

1
The review relies on existing guidelines and studies, which may have inherent limitations.
2
The optimal fluid therapy for SCI patients is unknown.
3
There is a need for further research to determine the most effective neuroprotective strategies and anesthetic agents for CSCI patients.

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