Rizk AA, Saad M, Singh M, Schaller B, Venkatraghavan L, Chowdhury T, et al.
Frontiers in medicine. Date of publication 2022 Mar 28;volume 9():852892.
1. Front Med (Lausanne). 2022 Mar 28;9:852892. doi: 10.3389/fmed.2022.852892.
eCollection 2022.
Perioperative Complications and Anesthesia Practices in Managing Patients With
Quadriplegia Undergoing Surgery: A Systematic Review.
Rizk AA(1), Saad M(1), Singh M(2), Schaller B(3), Venkatraghavan L(2), Chowdhury
T(2).
Author information:
(1)Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
(2)Department of Anesthesiology and Pain Medicine, Toronto Western Hospital,
University Health Network, Toronto, ON, Canada.
(3)Department of Pathophysiology, University of Buenos Aires, Buenos Aires,
Argentina.
Quadriplegia is associated with a multitude of health complications affecting
numerous organ systems. Complications during the perioperative periods are not
uncommon in this patient population due to abnormal responses to surgical
stressors. Such complications include autonomic dysreflexia, cardiac ischemia,
and respiratory compromise. Currently, there is no clear consensus on the ideal
technique for perioperative anesthesia management in this population. In
addition, the relationship between the perioperative complications and anesthesia
practices have not been explored in-depth. Therefore, we aimed to investigate
perioperative complications in the context of anesthesia that are associated with
patients with quadriplegia undergoing various surgical procedures. Our PRISMA
compliant systematic review included 12 articles covering the literature from
inception to January 12, 2021. The review showed complications being pulmonary,
cerebral, but most importantly and commonly cardiac in nature, with many patients
suffering hypertension, and many others hypotension. In addition, our review
showed that autonomic dysreflexia is common and in majority of patients, it was
managed successfully with good recovery. Based on our findings, the use of
anesthesia, either general or spinal, can be considered. Future studies are
needed to elucidate the exact mechanisms involved in perioperative complications
and anesthetic management that are associated with patients with quadriplegia.
This review will aid in developing general recommendations based on the
information available in the literature to guide perioperative management of this
vulnerable patient population.
Copyright © 2022 Rizk, Saad, Singh, Schaller, Venkatraghavan and Chowdhury.
DOI: 10.3389/fmed.2022.852892
PMCID: PMC8996073
PMID: 35419369
Conflict of interest statement: The authors declare that the research was
conducted in the absence of any commercial or financial relationships that could
be construed as a potential conflict of interest.
