A made uo case study on autonomic dysreflexia and a made up example question

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A 48-year-old female, ASA 3, presented for botulinum toxin injection due to neurogenic detrusor overactivity under GA. She had history of traumatic fracture at C7-T1 level at age 34, classified as ASIA A with C6 sensitive level and T1 motor level. She have experienced abrupt increased in BP and flushing in previous urodynamic studies. As she entered the operating room heart rate (HR) was 64bpm, BP 110/62mmHg, pulse oximetry 98%. After GA induction with IV fentanyl and propofol a LMA ProSealTM was introduced. Maintenance was made with air, oxygen and sevoflurane. During surgery trends showed a progressive decrease in HR followed by a progressive increase in BP to 160/90mmHg. At 20 min. of surgery HR decrease till 37 bpm, so 1mg IV atropin was given.

In Post-Anesthetic Care Unit she complain of headache, dry mouth, and flushing in neck and upper thorax was noted. The BP remained high (maximum: 188/121mmHg, minimum: 140/90mmHg). The urinary catheter was perme-able, so 10mg IV labetolol was given with complete reversion of symptoms. There weren't more complications during the hospital stay.

Nightingale answered 2 years ago

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