Background and Goal of Study:
There is wide variability in the treatment of acute traumatic spinal cord injuries (SCI) within the British Neurosurgical population.1 Our aim was to ascertain the current medical treatment of acute traumatic SCI injuries within the British Neuroanaesthetic community.
Materials and Methods:
A questionnaire survey via an online survey tool was sent to all full members of the Neuroanaesthetic Society of Great Britain and Ireland (NASGBI). Prior approval was obtained from the NASGBI. We asked about experience of the anaesthetist, intraoperative management during spinal surgery for traumatic SCI, and management in the intensive care unit in the week following injury. A total of 96 responded (37% response rate).
Desflurane (35%), TCI propofol and remifentanil (33%) and sevoflurane (27%) were the preferred anaesthetics used. Most neuroanaesthetists (96%) avoided agents known to increase intracranial pressure. Intraoperative monitoring was variable: 15% always measure central venous pressure; 78% invasive arterial blood pressure and 6% non invasive cardiac output. We assessed whether, in the intensive care unit, neuroanaesthetists manage spinal cord injury similar to brain injury. Only 3% consider mannitol or hypertonic saline. No one advocates hypothermia. Most (92%) maintain arterial pCO2 and pO2 within normal ranges. There was uncertainty about optimal mean arterial pressure; 54% aimed for ≥80 mmHg, with the use of inotropes if required.
There is variability in the anaesthetic management of SCI. Our data suggests British Neuroanaesthetists assume that the injured spinal cord responds in the same way as injured brain. Intraoperative monitoring, however, is more limited and their intensive care management does not follow the same principles as used for brain injury.
Werndle MC, Zoumprouli A, Bell BA, Papadopoulos MC. Acute traumatic spinal cord injuries: wide variability of treatment within the UK. British Journal of Neurosurgery. April 2011; 25(2):166.
© 2012 European Society of Anaesthesiology