Perioperative management of traumatic spinal cord injured patients after the acute phase

Objective. - To understand the physiopathology and the consequences of a traumatic spinal cord injury after the acute phase. The aim is to describe the preoperative management of these patients and the various anaesthetic techniques available. Data source. - The data were retrieved from the PubMed data base, papers from the major French anaesthesiology and intensive care conventions, publications from the French medico-surgical encyclopaedia, combined with reference analysis of major articles in this field. Results. - In France, there are 40,000 patients with traumatic spinal cord injury. These lesions lead to major handicap and frequent complications particularly urologic and orthopaedic ones. These patients often require surgical procedures under anaesthesia. Besides neurological deficits, the spinal cord injury leads to an imbalance between sympathetic and parasympathetic nervous systems with serious dysautonomic complications. During surgery, anaesthesia is necessary to prevent this autonomic dysreflexia. All anaesthetic techniques are usable and effective, subject to their careful implementation for those patients with cardiovascular and respiratory restricted adaptation. The use of suxamethonium can induce fatal hyperkaliemia for up to 10 years after the initial injury, with maximal frequency at six months post-trauma. Conclusion. - Notwithstanding insensitivity resulting from a spinal cord lesion, it is necessary to anaesthetize these patients before all surgical procedures. (C) 2008 Elsevier Masson SAS. Tous droits reserves.