Document Detail


Altered cardiovascular responses to tracheal intubation in patients with complete spinal cord injury: relation to time course and affected level.
MedLine Citation:
PMID:  20923869     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: We determined cardiovascular responses to tracheal intubation in relation to the time since injury in patients with different levels of spinal cord injury.
METHODS: Two hundred and fourteen patients with complete cord injury were studied. They were either quadriplegics (>C7, n=71) or paraplegics (<T5, n=143), and were subdivided into six groups each according to the time since injury: <4 week (acute), 4 week-1 yr, 1-5, 5-10, 10-20, and >20 yr. Twenty patients with no cord injury served as controls. Systolic arterial pressure (SAP), heart rate (HR), and plasma catecholamine concentrations were determined.
RESULTS: Intubation did not affect SAP in the quadriplegics regardless of the time post-injury, but it significantly increased SAP in all paraplegics. Moreover, the pressor response was enhanced in the paraplegics who were 10 yr or more since injury (P<0.05). HR increased significantly in all groups; the magnitude of the increase was less only in acute quadriplegics compared with controls. Plasma concentrations of norepinephrine increased in every group except for the quadriplegics within 4 weeks of injury. The maximum increases in SAP, HR, and norepinephrine from awake baseline values were smaller in the quadriplegics than in the paraplegics (P<0.01).
CONCLUSIONS: The cardiovascular and catecholamine responses to intubation change as a function of the time elapsed and the level of the cord injury. In this study, the pressor response to tracheal intubation was abolished in the quadriplegics but not in paraplegics; indeed, it was enhanced at 10 yr or more since injury in this group.
Authors:
K Y Yoo; C W Jeong; S J Kim; S T Jeong; S H Kwak; M H Shin; J Lee
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-10-05
Journal Detail:
Title:  British journal of anaesthesia     Volume:  105     ISSN:  1471-6771     ISO Abbreviation:  Br J Anaesth     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-11-18     Completed Date:  2010-12-13     Revised Date:  2011-03-16    
Medline Journal Info:
Nlm Unique ID:  0372541     Medline TA:  Br J Anaesth     Country:  England    
Other Details:
Languages:  eng     Pagination:  753-9     Citation Subset:  IM    
Affiliation:
Department of Anaesthesiology and Pain Medicine, Chonnam National University Medical School, 8 Hak-dong, Gwangju 501-190, Republic of Korea. kyyoo@jnu.ac.kr
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Anesthesia, General
Arrhythmias, Cardiac / etiology
Blood Pressure / physiology*
Epinephrine / blood
Female
Heart Rate / physiology*
Humans
Hypertension / etiology
Intraoperative Complications
Intubation, Intratracheal* / adverse effects
Laryngoscopy
Male
Middle Aged
Norepinephrine / blood
Paraplegia / etiology,  physiopathology
Quadriplegia / etiology,  physiopathology
Spinal Cord Injuries / complications,  physiopathology*
Time Factors
Young Adult
Chemical
Reg. No./Substance:
51-41-2/Norepinephrine; 51-43-4/Epinephrine
Comments/Corrections
Comment In:
Br J Anaesth. 2011 Mar;106(3):417-8; author reply 418   [PMID:  21317230 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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