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B218 Uncontrolled autonomic dysreflexia and anaesthesia: could continuous spinal block be a solution? A case report
  1. R De Oliveira,
  2. B Marques,
  3. C Barreto,
  4. C Pereira and
  5. L Coimbra
  1. Centro Hospitalar Vila Nova de Gaia/Espinho, E.P.E., 4434–502, Portugal


Background and Aims Autonomic dysreflexia usually occurs in patients with chronic spinal injuries above T6 level when subjected to provoking situations. Perioperative complications such as severe hypertension and bradycardia are a concern. Urologic interventions are main stress factors for inducing such events. Several studies state the benefit of regional anaesthesia in preventing autonomic dysreflexia. However, maintenance of hemodynamic stability may be more difficult to achieve with a single shot of local anaesthetic.

Methods Case Report

A 70-year-old male patient with history of spinal injury at C3-C6 level due to idiopathic syringomyelia with was admitted for an elective endoscopic lithotripsy, which was performed under general anesthesia. There were severe and refractive hypertensive peaks. Postoperative period complicated by a bladder of clots, which led to an urgent cystoscopy for clots evacuation. A continuous spinal block was performed. There was no haemodinamic instability after the first levobipivacaine 5 mg bolus. During the procedure, boluses were given when needed, maintaining haemodinamic stability. There were no postoperative complications.

Discussion Haemodinamic stability throughout urologic procedures in patients with autonomic dysreflexia is reportedly difficult to achieve using single shot spinal block. This report describes for the first time the use of a successful continuous spinal block for cystoscopy and blood clots evacuation in a patient who developed uncontrolled autonomic dysreflexia in a previous intervention.

Conclusions Continuous spinal block may be a good anaestehtic choice for patients with poorly controlled autonomic dysreflexia when subjected to urologic interventions.

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