A comparison of the efficacy of an alpha-I-adrenergic blocker in the slow calcium channel blocker in the control of autonomic dysreflexia

Lindan, Rosemary; Leffler, Elizabeth; Kedia, Kailash R.

doi:10.1038/sc.1985.6

Cited by 31 publications

(19 citation statements)

References 3 publications

(1 reference statement)

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“…Treatment options for AD are well established: removal of the triggering factor and if required symptomatic therapy using alpha-receptor blocker 24,25 or calcium-channel blocker. 26 In the present study, the intravenous application of the alpha-blocking agent phentolamine lowered the resting BP and increased the resting HR. During stimulation, the maximum BP increase was significantly reduced and severe hypertension prevented.…”

Section: Discussionsupporting

confidence: 52%

Autonomic dysreflexia in response to pudendal nerve stimulation

et al. 2003

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Study design: Pudendal nerve stimulation in complete spinal cord injury (SCI). Objective: To evaluate the influence of pudendal nerve stimulation on the cardiovascular system in SCI patients in order to assess the underlying neuronal mechanism and the potential risk during stimulation. Setting: Swiss Paraplegic Center, and University Hospital, Zurich. Methods: A total of 22 male patients with a complete SCI were divided into two groups according to the level of lesion: group A (C6-T6, n ¼ 15) and group B (T7-L2, n ¼ 7). A total of 66 stimulations using biphasic rectangular impulses (0.2 ms, 10 Hz) with intensities up to 100 mA were applied to the dorsal penile nerve. Of these, 15 stimulations in five patients were repeated after intravenous application of 7 mg of phentolamine. Heart rate (HR) and blood pressure (BP) were recorded by a Finapres s cuff applied to the right index finger. Results: Significant increased diastolic and systolic BP accompanied by significant decreased HR suggested the occurrence of autonomic dysreflexia (AD) during pudendal nerve stimulation. These cardiovascular changes corresponded with the subjective sensation of AD symptoms in patients of group A. Intravenous phentolamine lowered the resting BP and prevented severe hypertension during stimulation. Patients in group B presented with mild HR and BP changes in response to pudendal nerve stimulation and reported no AD symptoms. Conclusion: Our results show a considerable effect of electrical pudendal nerve stimulation on HR and BP in patients with high SCI. This may indicate that sacral somatic afferent fibers of the pudendal nerve are involved in the neuronal mechanism of AD in SCI patients with high neurological level. Intravenous phentolamine enables pudendal nerve stimulation without the risk of severe hypertension.

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Section: Discussionsupporting

confidence: 52%

Autonomic dysreflexia in response to pudendal nerve stimulation

et al. 2003

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“…Dykstra et al 41 studied the effect of sublingual nifedipine during cystoscopy and found that it significantly decreased mean SBP and diastolic blood pressure (DBP). Lindan et al 42 similarly found that it decreased blood pressure within 30-40 min. Thyberg et al 43 showed that prophylactic nifedipine significantly reduced maximum SBP and DBP, and blood pressure during cystometry.…”

Section: Treatment Of Ad During Other Ad Triggering Proceduresmentioning

confidence: 87%

“…Krassioukov et al, 33 however, mention that there is conflicting evidence on its effectiveness. Lindan et al 42 compared it with nifedipine in prophylaxis during cystometry and found that both drugs reduced resting blood pressure, but failed to prevent AD during bladder distension. Both medications caused hypotension at rest, requiring discontinuation of treatment or reduction of dose in some participants.…”

Section: Treatment Of Ad In Other Conditionsmentioning

confidence: 99%

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Sexual function and autonomic dysreflexia in men with spinal cord injuries: how should we treat?

Courtois

Rodrigue²,

Côté³

et al. 2012

Spinal Cord

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Study design: Systematic review. Objectives: Review the literature on the acute or prophylactic treatment of autonomic dysreflexia (AD) in the context of sexual activities. Setting: International Methods: Medline search using AD and spinal cord injury (SCI). Selected titles for AD treatment included all levels of evidence (randomized placebo control studies, case reports, literature reviews) and all years of publication. Results: Thirty-seven papers on the specific treatment of AD showed that nifedipine, prazosin, captopril and clonidine are candidates in the context of sexual activities. Prazosin, however, has an initial hypotensive effect requiring to begin treatment 12 h before intercourse, which makes it less ideal for spontaneous sexual activities. Captopril has an initial hypotensive effect and was only studied in acute AD. Its usefulness in prophylaxis remains to be demonstrated. Clonidine has successfully been used clinically for decades, but never studied in randomized control trials. Nifedipine remains the most widely studied and significant treatment of AD whether in acute or prophylactic conditions. Recent concerns suggest increased cardiovascular risks with sublingual nifedipine in non-SCI populations, but negative long-term effects have not been reported in the SCI population. Conclusion: Sexual function is a priority for men with SCI. As sexual activities, in particular ejaculation, can be a source of AD, adequate treatments and prophylaxis must be considered in the context of sexual activities. Experts must meet and conclude on the thresholds, parameters and treatments that should be considered in the long-term management of AD in the context of sexual function in men with SCI.

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“…Sublingual administration of nifedipine seems to be effective in the prevention of an expected attack, eg during cystoscopy, but methodological problems, like small numbers of comparable measure ments, lack of standardised stimuli and unspecified intervals of blood pressure measurement make the interpretation of previous studies difficult. [2][3][4][5] We have previously described the blood pressure response in repeated cystometries, and the aim of this study was to evaluate the effect of nifedipine with this improved technique.…”

Section: Introductionmentioning

confidence: 99%

Effect of nifedipine on cystometry-induced elevation of blood pressure in patients with a reflex urinary bladder after a high level spinal cord injury

Thyberg¹,

Ertzgaard²,

Gylling³

et al. 1994

Spinal Cord

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In 10 patients with a reflex urinary bladder after a cervical or high thoracic spinal cord injury, the effect of nifedipine on the cystometry-induced elevation of blood pressure was studied. The blood pressure was measured every 30 s in four consecutive cystometries before and after administration of 10 mg nifedipine sublingually. In each patient there was a decrease in the maximum systolic and diastolic blood pressure after the administration of nifedipine. In the whole group the mean maximum systolic pressure decreased significantly from 147 mmHg (range 119-165, SD 14) to 118 mmHg (range 99-145, SD 14). The mean maximum diastolic pressure decreased from 110 mmHg (range 96-124, SD 10) to 83 mmHg (range 71-99, SD 10). The effect of nifedipine was significant in each of the four cystometries that were performed. The decrease in blood pressure was due to both a significant decrease of the baseline pressure and a significant decrease of the blood pressure reaction during cystometry. Nifedipine may be useful in order to prevent dangerous blood pressure reactions, e.g. during cystoscopy and other diagnostic or therapeutic procedures in spinal cord injured patients with autonomic dysreflexia.

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A comparison of the efficacy of an alpha-I-adrenergic blocker in the slow calcium channel blocker in the control of autonomic dysreflexia

Cited by 31 publications

References 3 publications

Autonomic dysreflexia in response to pudendal nerve stimulation

Autonomic dysreflexia in response to pudendal nerve stimulation

Sexual function and autonomic dysreflexia in men with spinal cord injuries: how should we treat?

Effect of nifedipine on cystometry-induced elevation of blood pressure in patients with a reflex urinary bladder after a high level spinal cord injury

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