Perioperative management in acute and chronic spinal cord injury, narrative review.

IF 3.1
Israel Valdez-Resendiz, Estefany Nohemí Salgado-Camarillo, Fernanda Hernández-Morales, César Alejandro Martínez-de Los Santos, Chiara Robba
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Abstract

Spinal cord injury (SCI) causes temporary or permanent changes and alterations in patients' motor, sensory, or autonomic function, significantly impacting their quality of life and requiring clear goals and optimization of anesthesia and perioperative care for acute and chronic spinal cord injuries. SCI results from various etiologies and involving two principal pathophysiological mechanisms: primary and secondary injury. The first is result of the traumatic event, with irreversible neuronal damage, the second is generated as a consequence and in the minutes after the first and can continue for weeks or months causing degenerative damage to the spinal cord. It is in the secondary lesion where the objectives of anesthetic and perioperative management should be focused, especially in acute lesion. A conscientious and detailed preoperative evaluation allows to identify, injury level, evolution time, airway evaluation, cervical stability, hemodynamic status, ventilatory function and associated injuries must be determined. It is important to differentiate potential hemodynamic alterations and types of shock to prevent, especially in injuries greater than T6 and if necessary, provide early management in order to maintain adequate spinal cord perfusion. The objective of this review is to identify the pathophysiological mechanisms of spinal cord injury and the secondary systemic alterations and complications, as well as to establish specific optimization objectives during anesthetic management and perioperative care, which could reduce injury progression, prevent and control potential complications, and improve the quality of life of patients with this condition.

急慢性脊髓损伤的围手术期治疗,综述。
脊髓损伤(Spinal cord injury, SCI)可引起患者运动、感觉或自主神经功能的暂时性或永久性改变和改变,严重影响患者的生活质量,急慢性脊髓损伤的麻醉和围手术期护理需要明确目标和优化。脊髓损伤的病因多种多样,涉及两种主要的病理生理机制:原发性和继发性损伤。第一种是创伤事件的结果,具有不可逆转的神经元损伤,第二种是在第一种事件发生后的几分钟内产生的结果,可能持续数周或数月,导致脊髓退行性损伤。对于继发性病变,特别是急性病变,麻醉和围手术期管理的目标应予以重视。必须进行认真和详细的术前评估,以确定损伤程度、演变时间、气道评估、颈椎稳定性、血流动力学状态、通气功能和相关损伤。区分潜在的血流动力学改变和休克类型以预防是很重要的,特别是在大于T6的损伤中,如果有必要,提供早期治疗以保持足够的脊髓灌注。本文旨在探讨脊髓损伤的病理生理机制及其继发的全身改变和并发症,并在麻醉管理和围手术期护理中建立针对性的优化目标,以减少损伤进展,预防和控制潜在并发症,提高脊髓损伤患者的生活质量。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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