[Traumatic spinal cord lesion. An interdisciplinary challenge--a synopsis of the early trauma phase]

Increased morbidity and mortality in patients with spinal cord injuries present the anesthesiologist with many problems. The extent of neuronal damage is determined not only by the initial trauma, but also by subsequent activation of lipid peroxidation and lipase reactions due to local ischemia of the spinal cord. Complete transection of the spinal cord is characterized by impairment of diaphragmatic function and cardiovascular depression due to functional sympathectomy. Since hypoxemia is a common finding in high tetraplegics, immediate, careful intubation is mandatory at the trauma site. Because of rotational instability of the cervical spine, any brisk movement of the neck must be avoided. Therefore, orotracheal intubation may be performed only after sufficient stabilization of the spine in a neutral position has been guaranteed. Functional sympathectomy of the cardiovascular system is responsible for the hypotension frequently seen in high tetraplegics. Adequate volume replacement is provided based on central venous and pulmonary capillary wedge pressures. Reduced sympathetic tone causes increased sensitivity to volatile and intravenous anesthetics, so that myocardial depressants (e.g. halothane) should preferably be avoided. Opioid-induced anesthesia and nondepolarizing muscle relaxants should, therefore, be the anesthetic technique of choice.