Autonomic hyperreflexia during labour

Abstract

We present two cases of automatic hyperreflexia (,411) Autonomic hyperrcflexia occurs in about 85% of patients with spinal !esion above the level of "1"6. 2 This can be caused by noxious stimuli such as distention of the bladder, cervix, or rectum, which evoke a mass triggering of sympathetic and parasympathetic afferents below the level of the cord lesion that are not inhibited by supraspinal centres. Autonomic hyperreflexia is a serious complication during pregnancy, labour and delivery in the patient with spinal cord injury) We present two cases of AH during labour in women with spinal cord damage and comment upon the efficacy of epidural anaesthesia in managing the syndrome. Case reports Case #1The 33-yr-old white woman was admitted at the 37th week of gestation. She had become quadriplegic at the age of 16 yr following a spinal cord injury at the C3-5 level. Neurological examination revealed loss of sensory, motor, and reflex function below the C6 level and partial motor function at the C6 level. Although there was no evidence of preterm labour, an epidural catheter was placed in the I-,z-L3 epidural space, because she exhibited signs suggestive of AH such as facial flushing, sweating, and piloerection during abdominal distension or vaginal examination. The epidural catheter was placed at the 37th week of gestation and was kept in situ until its removal after delivery. No AH was observed with the epidural injection of 5 to l0 ml lidocaine 1%, given before each vaginal examination. At the 40th week of gestation, symptoms of AH such as pounding headache, hypertension, CAN J A N A E S T H 1995 / 4 2 : 1 2 / pp il34-6

Anesthetic management of parturients with pre-existing paraplegia or tetraplegia: a case series

“…Previous case reports and series have recommended epidural anesthesia as an effective method to prevent AH. 3,8,[10][11][12]25,29 Epidural meperidine has been reported to be successful; 30 however, epidural fentanyl failed to control AH. 25 Management of AH with intravenous anxiolytics and hydralazine is, however, often ineffective.…”

Management of autonomic dysreflexia

“…Spinal anesthesia has been reported to provide excellent control, and has been recommended in acute AD refractory to medical management [20][21][22][23][24][25][26][27][28][29].…”

Anestesia na Pré-Eclâmpsia

“…O labetalol possui propriedades antidisritmicas que protegem as pacientes do excesso de catecolaminas circulantes 9 . Anifedipina e os demais bloqueadores do canal do cálcio são potentes relaxantes da musculatura lisa vascular e podem aumentar o fluxo sangüíneo renal 54 . Agem rapidamente reduzindo a resistência vascular sistêmica e a pressão arterial.…”

“…Labelatol has anti-arrhythmic properties which protect patients from excessive circulating catecholamines 9 . Niphedipine and other calcium channel blockers are potent vascular smooth muscle relaxants and may increase renal blood flow 54 . They have a fast onset and decrease systemic vascular resistance and blood pressure.…”