Sneha Harish Rao and Joseph Schiandicola
Although the phenomenon of Autonomic Hyperreflexia (AHR) in patients undergoing bladder surgeries is well documented, there is very scarce literature regarding its presentation in other intra- abdominal surgeries. The life expectancy of patients with traumatic paraplegia in the age group of 20-40 yrs is about 25-45 yrs.
The survival of patients with spinal cord injuries (SCI) is increasing, these patients could present to the anaesthesiologist for a wide variety of surgeries. Autonomic dysreflexia (AD) also described as autonomic hyperreflexia (AHR) or mass reflex is characterized by a widespread reflex sympathetic discharge in patients with spinal cord lesions above the level of T6.
It presents as a life threatening medical emergency with elevated blood pressures. Our case presents a unique opportunity to discuss the implications of pneumo-peritoneum which is an essential aspect of most intra-abdominal surgeries.
Laparoscopic surgeries typically need gas insufflation at pressures of 15-20 mmHg at 2-4 litre/min. Insufflation pressures can cause a rise in intra-abdominal pressures leading to high SVR and increased myocardial contractility. CO2 absorption can cause rise in catecholamines which in turn induces hypertension and tachycardia. AHR although transient in nature could adversely affect these patients with poor myocardial and cardiovascular reserve leading to myocardial infarction, atrial fibrillation, LV failure, seizures and intra-cerebral haemorrhage.
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