Skip to main content Accessibility help
  • Print publication year: 2011
  • Online publication date: December 2011

24 - Spinal cord injury

from Section 4 - Neurointensive care


This chapter discusses the anaesthetic management of intracranial vascular abnormalities with particular emphasis on subarachnoid haemorrhage (SAH), arteriovenous malformations (AVMs) and carotid artery stenosis. Cerebral aneurysms occur mainly at vascular bifurcations within the circle of Willis or proximal cerebral artery. Patients with salt-wasting syndrome are hypovolaemic and require fluid to prevent intravascular volume contraction. Interventional neuroradiology is being used increasingly to treat central nervous system (CNS) disease by either delivering therapeutic devices or by administering drugs at the point of need. During periods of acute vascular occlusion or vasospasm, induced hypertension can maintain cerebral perfusion by increasing flow across the circle of Willis. Patients presenting for carotid surgery are elderly and often have coexisting medical problems common to patients with vascular disease. These include coronary artery disease, chronic pulmonary airway disease and diabetes mellitus.

Further reading

Ackland, G. L. and Fox, R. (2005) Low-dose propofol infusion for controlling acute hyerspasticity after withdrawal of intrathecal baclofen therapy. Anesthesiology 103, 663–5.
Adams, M. M. and Hicks, A. L. (2005) Spasticity after SCI. Spinal Cord 43, 577–86.
Bach, J. R. and Saporito, L. R. (1996). Criteria for extubation and tracheostomy tube removal for patients with ventilatory failure. Chest 110, 1566–71.
Berney, S., Bragge, P., Granger, C., Opdam, H. and Denehy, L. (2010). The acute respiratory management of cervical spine cord injury in the first 6 weeks after injury: a systematic review. Spinal Cord 49, 17–29.
Bracken, M. B., Shepard, M. J., Collins, W. F. et al. (1990). A randomized controlled trial of methylprednisolone or naloxone in the treatment of acute SCI. New Engl J Med 322, 1405–11.
Bravo, G., Guízar-Sahagún, G., Ibarra, A., Centurión, D. and Villalón, C. M. (2004). Cardiovascular alterations after spinal cord injury: an overview. Curr Med Chem Cardiovasc Hematol Agents 2, 133–48.
Chiodo, A. E., Scelza, W. and Forchheimer, M. (2007) Predictors of ventilator weaning in individuals with high cervical spinal cord injury. J Spinal Cord Med 31, 72–7.
Coffey, R. J., Edgar, T. S., Francisco, G. E. et al. (2002). Abrupt withdrawal from intrathecal baclofen: recognition and management of a potentially life-threatening syndrome. Arch Phys Med Rehabil 83, 735–41.
Como, J. J., Sutton, E. R., McCunn, M. et al. (2005). Characterising the need for mechanical ventilation following cervical spinal cord injury with neurological deficit. J Trauma 59, 912–16.
Gelis, A., Dupeyron, A., Legros, P. et al. (2009). Pressure ulcer risk factors in persons with spinal cord injury: part I: acute and rehabilitation stages. Spinal Cord 47, 99–107.
Gore, R. M., Mintzer, R. A. and Calenoff, L. (1981) Gastrointestinal complications of spinal cord injury. Spine 6, 538–44.
Green, D., Hartwig, D., Chen, D., Soltysik, R. C. and Yarnold, P. R. (2003). Spinal cord injury risk assessment for thromboembolism (SPIRATE Study). Am J Phys Med Rehabil 12, 950–6.
Gupta, R., Bathen, M. E., Smith, J. S. et al. (2010). Advances in the management of spinal cord injury. J Am Acad Orthop Surg 18, 210–22.
Guterrez, C. J., Harrow, J. and Haines, F. (2003). Using an evidence-based protocol to guide rehabilitation and weaning of ventilator-dependent cervical spinal cord injury patients. J Rehabil Res Dev, 40, 99–110.
Hurlbert, R. J. (2006). Strategies of medical intervention in the management of acute spinal cord injury. Spine 31, S16–21.
Khan, S., Plummer, M., Martinez-Arizala, A. and Banovac, K. (2007). Hypothermia in patients with chronic spinal cord injury. J Spinal Cord Med, 30, 27–30.
Krassioukov, A., Warburton, D. E., Teasell, R. et al. (2009). A systemic review of the management of autonomic dysreflexia after spinal cord injury. Arch Phys Med Rehab 90, 682–95.
Lynch, A. C., Palmer, C., Lynch, A. C. et al. (2002). Nutritional and immune status following spinal cord injury: a case controlled study. Spinal Cord 40, 627–30.
Mansel, J. K. and Norman, J. R. (1990). Respiratory complications and management of spinal cord injuries Chest 97, 1446–52.
National Spinal Cord Injury Statistical Center (2009). Spinal cord injury facts and figures at a glance. Available at:
Onose, G., Anghelescu, A., Muresanu, D. F. et al. (2009). A review of published reports on neuroprotection in spinal cord injury. Spinal Cord 47, 716–26.
Peterson, W. P., Barbalata, L., Brooks, C. A. et al. (1999). The effect of tidal volumes on the time to wean persons with high tetraplegias from ventilators. Spinal Cord 37, 284–8.
Ploumis, A., Yadlapalli, N., Fehlings, M. G., Kwon, B. K. and Vaccaro, A. R. (2010). A systematic review of the evidence supporting a role for vasopressor support in acute SCI. Spinal Cord 48, 356–62.
Prigent, H., Roche, N., Laffont, I. et al. (2009). Relation between corset use and lung function postural variation in spinal cord injury. Eur Respir J 35, 1126–9.
Schilero, G. J., Spungen, A. M., Bauman, W. A., Radulovic, M. and Lesser, M. (2009). Pulmonary function and spinal cord injury. Arch Phys Med Rehabil 166, 129–41.
Sekhon, L. H. and Fehlings, M. G. (2001). Epidemiology, demographics and pathophysiology of acute spinal cord injury. Spine 26, S2–12.
Short, D. J., El Masry, W. S. and Jones, P. W. (2000). High dose methylprednisolone in the management of acute spinal cord injury – a systematic review from a clinical perspective. Spinal Cord 38, 273–86.
Stiens, S. A., Bergman, S. B. and Goetz, L. L. (1997). Neurogenic bowel dysfunction after spinal cord injury: clinical evaluation and rehabilitative management. Arch Phys Med Rehabil 78, S86–99.
Thibault-Halman, G., Casha, S., Singer, S. and Christie, S. (2010). Acute management of nutritional demands after spinal cord injury. J Neurotrauma 27, 1–11.
Vale, F. L., Burns, J., Jackson, A. B. and Hadley, M. N. (1997). Combined medical and surgical treatment after acute spinal cord injury: results of a prospective pilot study to assess the merits of aggressive medical resuscitation and blood pressure management. J Neurosurg 87, 239–46.
Winslow, C. and Rozovsky, J. (2003). Effect of spinal cord injury on the respiratory system. Am J Phys Med Rehabil 82, 803–14.