Severe hypertension in patients with high spinal cord lesions undergoing electro-ejaculation—Management with prostaglandin E2

Frankel, H L

doi:10.1038/sc.1980.52

Cited by 40 publications

(27 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[1][2][3][4] These clinical and experimental observations suggest that pudendal afferent fibers might be involved in dysregulations of the autonomic nervous system after SCI. However, the underlying neuronal mechanism and involved pathways for these observations are not clear.…”

Section: Introductionmentioning

confidence: 85%

Autonomic dysreflexia in response to pudendal nerve stimulation

et al. 2003

View full text Add to dashboard Cite

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.

show abstract

Section: Introductionmentioning

confidence: 85%

Autonomic dysreflexia in response to pudendal nerve stimulation

et al. 2003

View full text Add to dashboard Cite

show abstract

“…Frankel et al 21 reported that cardiovascular change during electrical stimulation was dependent on the degree of lesion in spinal injuries. They also reported that the syndrome of autonomic dysre¯exia might occur in patients with high thoracic and cervical cord lesions.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of spinal cord blood flow during prostaglandin E1-induced hypotension with power Doppler ultrasonography

et al. 2001

View full text Add to dashboard Cite

Study design: Intraoperative power Doppler ultrasonography was used to evaluate the spinal cord blood¯ow in cervical spondylotic myelopathy patients during hypotensive anesthesia. Objective: To evaluate the e ect of prostaglandin E1 (PGE1) induced hypotension on spinal cord blood¯ow (SBF) during spinal surgery. Summary and background data: Hypotension is frequently induced to decrease blood loss during surgery and to diminish the need for blood transfusion. Prostaglandin E1 (PGE1) is reported to maintain cerebral, liver, and renal blood¯ow during surgery. However, there are few reports on spinal cord blood¯ow. Methods: Eleven patients underwent laminoplasty for cervical spondylotic myelopathy. After a French door type laminoplasty was carried out, hypotension was induced with PGE1. Before and during hypotension, we evaluated blood¯ow in the anterior spinal cord artery by determining the pulsatility index (PI) and resistance index (RI) using power Doppler ultrasonography. Results: Before hypotension, the mean blood pressure was 80 mmHg. The blood pressure decreased to 60 mmHg using PGE1 (P50.01), although the PI and RI were signi®cantly higher than before hypotension (PI, P=0.0076 RI, P=0.02). Conclusion: The pulsatility and resistance indices during hypotension were signi®cantly higher than before hypotension, suggesting that the autoregulation of the anterior spinal cord artery and anterior spinal cord blood¯ow were maintained with hypotension using PGE1. Prostaglandin E1 may be a useful drug for hypotensive anesthesia in spinal surgery. Spinal Cord (2001) 39, 31 ± 36

show abstract

“…Severe hypotension in contrast was observed on some tetraplegic individuals. Frankel et al 39 found that intravenously prostaglandin E2, another vasodilator, reduced blood pressure during electroejaculation, but the report only concerned three cases.…”

Section: Treatment Of Ad During Ejaculation Proceduresmentioning

confidence: 99%

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

Courtois

Rodrigue²,

Côté³

et al. 2012

Spinal Cord

View full text Add to dashboard Cite

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.

show abstract

Severe hypertension in patients with high spinal cord lesions undergoing electro-ejaculation—Management with prostaglandin E2

Cited by 40 publications

References 11 publications

Autonomic dysreflexia in response to pudendal nerve stimulation

Autonomic dysreflexia in response to pudendal nerve stimulation

Evaluation of spinal cord blood flow during prostaglandin E1-induced hypotension with power Doppler ultrasonography

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

Contact Info

Product

Resources

About