Abstract
Autonomic dysreflexia (AD) is a life-threatening complication of spinal cord injury at T6 or above that results in an uncontrolled sympathetic response secondary to a precipitant. If not recognized as a medical emergency and promptly treated, acute AD may result in devastating complications. Health care providers should be aware of the potential causes of AD and how to treat it when it occurs. This article reviews the acute management of AD, with special consideration to anesthesia and pregnant patients. The key to successful management of recurrent AD is prevention through education, identification, and avoidance of noxious stimuli.
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Shergill I, Arya M, Hamid R, et al.: The importance of autonomic dysreflexia to the urologist. BJU Int 2004, 93:923–926.
Karlsson AK: Autonomic dysreflexia. Spinal Cord 1999, 37:383–391.
Lindan R, Joiner E, Freehafer AA, et al.: Incidence and clinical features of autonomic dysreflexia in patients with spinal cord injury. Paraplegia 1980, 18:285–293.
Kursh ED, Freehafer A, Persky L: Complication of autonomic dysreflexia. J UroI 1977, 118:70–72.
Eltorai L, Kim R, Vulpe M, et al.: Fatal cerebral hemorrhage due to autonomic dysreflexia in a tetraplegic patient. Case report and review. Paraplegia 1992, 30:355–360.
Pine ZM, Miller SD, Alonso JA: Atrial fibrillation associated with autonomic dysreflexia. Am J Phys Med Rehabil 1991, 70:271–273.
Vallès M, Benito J, Portell E, Vidal J: Cerebral hemorrhage due to autonomic dysreflexia in a spinal cord injury patient. Spinal Cord 2005, 43:738–740.
Pan SL, Wang YH, Lin HL, et al.: Intracerebral hemorrhage secondary to autonomic dysreflexia in a young person with incomplete C8 tetraplegia: a case report. Arch Phys Med Rehabil 2005, 86:591–593.
Blackmer J: Rehabilitation medicine: 1. Autonomic dysreflexia. CMAJ 2003, 169:931–935.
Paralyzed Veterans of America/ Consortium for Spinal Cord Medicine: Acute Management of Autonomic Dysreflexia: Individuals with Spinal Cord Injury Presenting to Health Care Facilities. 2nd ed. Washington, DC: Paralyzed Veterans of America (PVA); 2001:29.
Braddom KL, Rocco JF: Autonomic dysreflexia. A survey of current treatment. Am J Phys Med Rehabil 1991, 70:234–241.
Dykstra DD, Sidi AA, Anderson LC: The effect of nifedipine on cystoscopy-induced autonomic hyperreflexia in patients with spinal cord injuries. J Urol 1987, 138:1155–1157.
Thyberg M, Ertzgaard P, Gylling M, Granerus G: Effect of nifedipine on cystometry-induced elevation of blood pressure in patients with a reflex urinary bladder after a high level spinal cord injury. Paraplegia 1994, 32:308–313.
Grossman E, Messerli FH, Grodzicki T, Kowey P: Should a moratorium be placed on sublingual nifedipine capsule given for hypertensive emergencies and pseudo-emergencies? JAMA 1996, 276:1328–1331.
Abrams P, Amarenco G, Bakke A, et al.: Tamsulosin: efficacy and safety in patients with neurogenic lower urinary tract dysfunction due to suprasacral spinal cord injury. J Urol 2003, 170:1242–1251.
Scott MB, Morrow JW: Phenoxybenzamine in neurogenic bladder dysfunction after spinal cord injury. II. Autonomic dysreflexia. J Urol 1978, 119:483–484.
McGuire J, Wagner FM, Weiss RM: Treatment of autonomic dysreflexia with phenoxybenzamine. J Urol 1976, 115:53–55.
Esmail Z, Shalansky K, Sunderji R, et al.: Evaluation of captopril for the management of hypertension in autonomic dysreflexia: a pilot study. Arch Phys Med Rehabil 2002, 83:604–608.
Vaidyanathan S, Soni BM, Sett P, et al.: Pathophysiology of autonomic dysreflexia: long-term treatment with terazosin in adult and paediatric spinal cord injury patients manifesting recurrent dysreflexia episodes. Spinal Cord 1998, 36:761–770.
Hambly P, Martin B: Anaesthesia for chronic spinal cord lesions. Anaesthesia 1998, 53:273–289.
Burns AS, Jackson AB: Gynecologic and reproductive issues in women with spinal cord injury. Phys Med Rehabil Clin North Am 2001, 12:183–199.
Greenspoon JS, Paul RH: Paraplegia and quadriplegia. Special consideration during pregnancy and labor and delivery. Am J Obstet Gynecol 1986, 155:738–741.
Cross LL, Meythaler JM, Tuel SM, Cross AL: Pregnancy, labor and delivery post spinal cord injury. Paraplegia 1992, 30:890–902.
Burns R, Clark VA: Epidural anaesthesia for caesarean section in a patient with quadriplegia and autonomic hyperrreflexia. Int J Obstet Anesth 2004, 13:120–123.
Kobayashi A, Mizobe T, Tojo H: Autonomic hyperreflexia during labour. Can J Anaesth 1995, 42:1134–1136.
Gunaydin B, Akcali D, Alkan M: Epidural anaesthesia for Caesarean section in a patient with Devic’s syndrome. Anaesthesia 2001, 56:565–567.
Murphy B, McGuire G, Peng P: Treatment of autonomic hyperreflexia in a quadriplegic patient by epidural anesthesia in the postoperative period. Anesth Analg 1999, 879:148–149.
Colachis SC 3rd: Autonomic hyperreflexia with spinal cord injury. J Am Paraplegic Soc 1992, 15:171–186.
Tabsh K, Brinkman CR 3rd, Reff RA: Autonomic dysreflexia in pregnancy. Obstet Gynecol 1982, 60:119–122.
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Breault, G., Altaweel, W. & Corcos, J. Management of autonomic dysreflexia. Curr Bladder Dysfunct Rep 3, 13–16 (2008). https://doi.org/10.1007/s11884-008-0003-x
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DOI: https://doi.org/10.1007/s11884-008-0003-x