Silent Autonomic Dysreflexia During Voiding in Men with Spinal Cord Injuries

Linsenmeyer, Todd A.; Campagnolo, Denise I.; Chou, I.-Hsin

doi:10.1097/00005392-199602000-00030

Cited by 32 publications

(70 citation statements)

References 11 publications

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“…Linsenmeyer et al 9 examined the AD reaction during urodynamic evaluation and emphasized that the increase in BP in patients with uninhibited bladder contractions was not caused by bladder distension per se, but by bladder distension triggering an uninhibited bladder contraction. Among the bladder management methods for persons with SCI, reflex voiding is the only one that uses uninhibited bladder contraction.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, AD was defined by the International ASIA/ISCoS Autonomic Standards Committee as a rise of 20 mm Hg above the resting BP. 4 It is also probable that we did not include some subjects who lacked the classical symptoms, that is, 'silent' AD, 9 because AD was defined as elevation of systolic BP and appearance of classical AD symptoms in this study. Further research is needed to examine 'silent' AD.…”

Section: Discussionmentioning

confidence: 99%

“…A number of studies examined the AD reaction during urodynamic evaluation 9,10 and actual bowel program. 11,12 Our group previously investigated the AD responses before, during and after a bowel program involving manual removal of stool in lateral recumbency in patients with cervical SCI.…”

Section: Introductionmentioning

confidence: 99%

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Incidence of symptomatic autonomic dysreflexia varies according to the bowel and bladder management techniques in patients with spinal cord injury

Furusawa¹,

Tokuhiro²,

Sugiyama³

et al. 2010

Spinal Cord

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Study design: A retrospective, multicenter study. Objectives: To investigate the relationship between bowel and bladder management methods and symptomatic autonomic dysreflexia (AD) during hospitalization in patients with spinal cord injury (SCI). Setting: Twenty-eight Rosai hospitals in Japan. Methods: The study subjects were 571 patients with SCI who had been admitted to 28 Rosai hospitals between April 1997 and March 2007 for rehabilitation therapy and fulfilled the following criteria: (1) SCI at or above sixth thoracic level, (2) discharged from hospital after more than 4 months of admission for initial injury and (3) lack of pressure ulcers, deep venous thrombosis, ureteral and renal stones or heterotopic ossification throughout hospitalization to exclude possible influence of these complications on cardiovascular reflexes. The study subjects were examined for the incidence of symptomatic AD according to age, sex, ASIA Impairment Scale, injury level, bowel and bladder management techniques at discharge. Results: The Rosai Hospital registry included 3006 persons with SCI during 1997-2007, and 571 patients fulfilled the above criteria. The highest incidence of symptomatic AD was diagnosed in subjects using reflex voiding and in those using manual removal of stool. By contrast, the lowest incidence of symptomatic AD was in those on continent spontaneous voiding and continent spontaneous defecation. Conclusion: Medical staff should evaluate the presence of AD in patients with SCI at or above the T6 level under bladder and bowel management such as reflex voiding and manual removal of stool.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Incidence of symptomatic autonomic dysreflexia varies according to the bowel and bladder management techniques in patients with spinal cord injury

Furusawa¹,

Tokuhiro²,

Sugiyama³

et al. 2010

Spinal Cord

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“…1,3 Serious morbidity, like consciousness change, visual disturbances, seizures, intracranial hemorrhage or even death, is primarily associated with sudden and marked rises in blood pressure (BP). [4][5][6] Symptoms (that is, headache, facial flushing, chills or sweating) are usually used as warning signs of BP elevation, although sometimes there is no presenting symptoms when BP is elevated, a condition referred to as silent AD. 6 In such cases, patients and physicians may miss the ideal time to manage the underlying strong afferent stimuli until serious sequelae ensue.…”

Section: Introductionmentioning

confidence: 99%

“…[4][5][6] Symptoms (that is, headache, facial flushing, chills or sweating) are usually used as warning signs of BP elevation, although sometimes there is no presenting symptoms when BP is elevated, a condition referred to as silent AD. 6 In such cases, patients and physicians may miss the ideal time to manage the underlying strong afferent stimuli until serious sequelae ensue.…”

Section: Introductionmentioning

confidence: 99%

Blood pressure and age associated with silent autonomic dysreflexia during urodynamic examinations in patients with spinal cord injury

et al. 2012

Spinal Cord

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Study design: An observational study. Objectives: To investigate the factors associated with silent autonomic dysreflexia (AD) during urodynamics (UD) in spinal cord injury (SCI) patients. Setting: Taichung city, Taiwan, ROC. Methods: Blood pressure (BP) and symptoms of AD were continuously monitored during UD, and systolic blood pressure (SBP) elevations 420 mmHg was considered an AD reaction. AD patients were divided into a symptomatic group and a silent group (without AD symptoms), and variables (basic demographic data, hemodynamic data and UD parameters) were compared. Results: A total of 42 patients, 21 in symptomatic and 21 in silent AD groups, were analyzed. Symptomatic group had significantly greater diastolic blood pressure (DBP) increment and rates of SBP/DBP changes (change of BP divided by duration) as compared to the silent group (29.5 vs 21.7 mmHg; 4.8 vs 2.3 mmHg min À1 and 2.8 vs 1.4 mmHg min À1 ) (Po0.05). The cutoff points of these three variables, determined by receiver operating characteristic analysis, are: DBP increment of 21 mmHg and rates of SBP/DBP change of 2.27 and 1.16 mmHg min À1 . Age had a weak negative correlation with DBP change (Pearson's r ¼ À0.377, P ¼ 0.048) and the silent group was significantly older than the symptomatic group (49.4 vs 40.1 years, Po0.05). Conclusion: Patients with more symptomatic AD tended to have significant DBP elevation and more rapid SBP/DBP increments, and this was negatively correlated with age. Aging decreases AD symptoms and the magnitude of DBP elevation, possibly through the mechanism of decreased baroreceptor sensitivity. BP monitoring during UD and other invasive procedures is strongly recommended, especially for elderly SCI patients.

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Onset of the action of intravesical lidocaine after spinal cord injury

Solinsky

Tam

Linsenmeyer

2019

Neurourology and Urodynamics

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Aims: To obtain objective evidence for the time to onset of action for intravesical lidocaine utilizing exaggerated sympathetic blood-pressure responsiveness in patients with spinal cord injuries (SCI). Methods: This prospective observational cohort study analyzed blood pressure responses in individuals with SCI at or above T6 who did (lidocaine-instillation group) or did not (control group) receive 10 ml of 2% lidocaine gel instilled through their catheters before routine suprapubic catheter change. Care was taken to minimize any potentially confounding position change or catheter manipulation. Given the potential for C-fiber mediated systolic blood pressure (SBP) increases after SCI, the time to lidocaine's onset of action for blocking these C-fibers (as seen by the decrease in SBP more than and equal to 10 mm Hg) was assessed with serial blood pressures for 4 to 6 minutes. Results: Blood pressures were evaluated in 32 individuals with SCI (lidocaineinstillation group n = 22, control group n = 10). In the lidocaine-instillation group, 45% individuals demonstrated a sustained decrease in SBP more than and equal to 10 mm Hg, which occurred at a mean of 98.1 seconds (SD 59 seconds) after lidocaine instillation. Despite up to 6 minutes of serial monitoring, the remainder of the lidocaine-instillation group and the entire control group had SBP fluctuations less than 10 mm Hg. The serial mean SBPs of those who responded to lidocaine were significantly less than the remaining groups (P < .001 for both comparisons).Conclusion: Utilizing lidocaine's properties to decrease sympathetic-inducing afferents after SCI, the time to onset of action for intravesical lidocaine was found to be approximately 90 seconds. This relatively rapid initial onset on action is especially pertinent when managing autonomic dysreflexia. K E Y W O R D S autonomic dysreflexia, lidocaine, pharmacology, spinal cord injury

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Silent Autonomic Dysreflexia During Voiding in Men with Spinal Cord Injuries

Abstract: Urodynamics are helpful to detect symptomatic and asymptomatic autonomic dysreflexia. Significant elevations in blood pressure can occur without the symptoms of autonomic dysreflexia.

Cited by 32 publications

References 11 publications

Incidence of symptomatic autonomic dysreflexia varies according to the bowel and bladder management techniques in patients with spinal cord injury

Incidence of symptomatic autonomic dysreflexia varies according to the bowel and bladder management techniques in patients with spinal cord injury

Blood pressure and age associated with silent autonomic dysreflexia during urodynamic examinations in patients with spinal cord injury

Onset of the action of intravesical lidocaine after spinal cord injury

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