Anaesthetic requirement in spinal cord injured patients undergoing operation below the level of cord injury

Anaesthesia in spinal cord injured (SCI) can be hazardous. In complete injuries above T6, the abnormal state of the respiratory and the cardiovascular systems pose special problems. The objective of this study therefore was to evaluate the anaesthetic requirements in patients with complete SCI undergoing operation below the level of the cord lesion. The medical records and the operation notes of all patients with complete SCI who underwent surgical operations between January 2001 and December 2005 were reviewed. Information about their demographics, level of injury, indications for operation, type of operation done and the type anaesthesia used were collated. The choice anaesthesia was guarded by the proximity of operation site to the level of cord transaction and by patient's preference. The pre-operative and intra-operative blood pressure, pulse rate and respiratory rate were used to monitor cardiovascular and respiratory responses. They were twenty-eight, all male except one. The age range was 13-67 years with an average of32 years. The level of cord lesion varied. The thoracic spine was most involved followed by the cervical spine. The most common indication for operation was pressure sore. The anesthetic requirement varied, and ranged from general anesthesia (GA) to no anaesthesia at all. Three broad groups were observed: no anaesthesia; sedation with diazepam; and general anaesthesia. There was no remarkable change in the blood pressure readings in the three groups. However, three patients who had GA and whose operation sites were in the twilight zone had remarkable changes in the pulse and respiratory rates. Even though spinal patients are insensate below the level of their injury, significant proportions that need operation below the level of cord lesion require anaesthesia.