Skip to main content Accessibility help
×
Home
  • Print publication year: 2011
  • Online publication date: May 2011

Case 48 - Pronecardiopulmonary resuscitation

from Section I - Neuroanesthesia

Summary

Spinal cord injury (SCI) is a devastating, life-threatening condition that produces a number of physiologic and anatomical derangements that must be acutely managed by the anesthetic team. This chapter presents a case study of a 26-year-old male with a loss of sensation and motor control from the neck down. The patient was scheduled for an immediate posterior cervical decompression and stabilization by the neurosurgical service. The patient was evaluated in the emergency room for other associated injuries and high-dose methylprednisolone was started. Maintenance of anesthesia included propofol and remifentanil infusions, in order to facilitate spinal cord monitoring with somatosensory and motor evoked potentials. The postoperative care of these patients might be extensive requiring multiple further anesthetics. Anesthesiologists must be familiar with the unique long-term complications of SCI such as spasticity, autonomic hyperreflexia, and chronic ventilator support that may alter anesthetic management.

References

1. S. L. Beltran, G. A. Mashour. Unsuccessful cardiopulmonary resuscitation during neurosurgical procedures: is the supine position always optimal? Anesthesiology 2008; 108: 163–4.
2. E. L. McNeil. Re-evaluation of cardiopulmonary resuscitation. Resuscitation 1989; 18: 1–5.
3. S. T. Higano, J. K. Oh, G. A. Ewy et al. The mechanism of blood flow during closed chest cardiac massage in humans: transesophageal echocardiographic observations. Mayo Clin Proc 1990; 65: 1432–40.
4. C. F. Babbs. New versus old theories of blood flow during CPR. Crit Care Med 1980; 8: 191–5.
5. S. P. Mazer, M. Weisfeldt, D et al. Reverse CPR: A pilot study of CPR in the prone position. Resuscitation 2003; 57: 279–85.
6. J. Wei, D. Tung, S. H. Sue et al. Cardiopulmonary resuscitation in prone position: a simplified method for outpatients. J Chin Med Assoc 2006; 69: 202–6.