Autonomic Hyperreflexia

Autonomic hyperreflexia: • Post spinal cord injury above T-7 → 70-75%, following the resolution of spinal shock, 2-3 weeks after injury • Stimulation below the level of transection →Severe HTN with bradycardia A→ potential difficult A/W, unstable C-spine, aspiration risk (FOI), (RSI) B→ ↓ respiratory reserve and volumes, risk of aspiration, pneumonia, PE, respiratory failure → PFT, ABG, → post-op vent (ICU) C→ hyperreflexia, orthostatic hypotension, assess the volume status. ECG, D→ (Sux C/I), have anti-HTN ready (Niprid) N. stimulator → show resistance N→ deficit • Neuraxial → best is a good choice but may be difficult to assess the level of the block too high, or too low • Hyper-reflexia may happen post-op due to bladder or rectal distension. • Sequelae → CV collapse, arrhythmias, pul edema, stroke, seizure, death