Vimmi Kang, DO
Dooney N, Dagal A. Anesthetic considerations in acute spinal
cord trauma. Int J Crit Illn Inj Sci 2011;1:36-43
This article reviews the
anesthetic considerations for spinal cord trauma. It starts off defining
primary and secondary injury. Primary being the injury that occurs at time of
injury and secondary injury is what develops within minutes like inflammation
and edema.
Techniques for airway management that are discussed are manual in line stabilization and rigid collar
during larngoscopy. Manual in line stabilization provides a better view on DL
than using a rigid collar. Patient is also easier to mask during ventilation.
It was also stressed to provide the least amount of jaw thrust and chin lift to
minimize any compression to the cervical spinal.
Succinylcholine should be avoided
from three to nine months after spinal cord injury. Rocuronium is a safe alternative.
The next section discusses blood
pressure management. Spinal cord perfusion pressure is autoregulated just like cerebral perfusion
pressure and thus maintained over a
range of systemic blood pressures.
Fluid Management of colloids
versus crystalloid is still a debate.
Hypotonic crystalloids may worsen edema and cord swelling and thus
should be avoided. Albumin use is relatively contraindicated due to study from
SAFE-TBI of increased mortality in patients with traumatic brain injury.
Lastly, on the discussion of
corticosteroids it was stated that the use of steroids after reviewing risk and
benefits is the not the standard of care, just a treatment option.
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