Epidural in a quadriplegic

October 1, 2008

An anesthesiologist writes about some of the finer points of sedating a quadriplegic during surgery:

For a patient with a spinal cord injury, I prepare for the worst. There are all sorts of challenges – maintaining a good airway and adequate oxygenation and ventilation; moving and positioning; and last but not least, the dreaded phenomenon of autonomic dysreflexia, in which surgical stimulation can produce out-of-control blood pressures and cardiac disturbances that can be life-threatening.

Sometimes however, the emotional challenges of such cases can be draining:

When I touch him to connect physically while speaking to him from the top of the bed as I wheel it into the O.R., I touch his head rather than his shoulder, because I know he can’t feel my reassurance otherwise…and then I wonder if touch is reassuring or not for him.

Well put.



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