| Risk factors |
- Spinal cord injury above T6
- History of AD
|
| Clinical signs and symptoms* |
- Sudden hypertension; systolic blood pressure may be >200 mmHg
- Dysrhythmias: Bradycardia, tachycardia, heart block, sinus arrest all possible
- Vasoconstriction below spinal lesion, vasodilation above the lesion
- Facial flushing
- Headache, in awake patients
- Nasal congestion, in awake patients
- Acute left heart failure
- Myocardial infarction
- Intracranial hemorrhage
- Seizures
|
| Treatment |
- Remove inciting stimulus
- Stop surgery
- Empty bladder
- Look for distention of viscus
- Deepen anesthesia if under general anesthesia
- Administer propofol bolus
- Increase inhalation agent
- Position head-up to take advantage of orthostatic blood pressure drop
- Administer 100% oxygen
- Administer short-acting vasodilator:
- Nicardipine bolus (0.2 to 0.5 mg IV) and infusion (2.5 to 25 mg/hour IV, titrated to effect), or
- Nitroglycerin infusion (5 to 500 mcg/minute IV)¶, or
- For severe hypertension, nitroprusside infusion¶ (0.2 to 10 mcg/kg/minute IV)
- If longer-acting vasodilator is requiredΔ
- Hydralazine (5 mg IV every 10 minutes titrated to effect, up to 20 mg total dose)
- Labetalol (5 mg IV every 5 minutes titrated to effect, up to 50 mg total dose)◊
- Treat arrhythmias as necessary
- Treat myocardial ischemia (ie, ST changes on electrocardiogram) as necessary
- Place intraarterial catheter for blood pressure monitoring if resolution does not occur quickly
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