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Autonomic Dysreflexia


Learning Objectives

  • Describe the pathophysiology of autonomic dysreflexia.

  • Recognize signs and symptoms of autonomic dysreflexia.

  • Describe prevention and treatment of autonomic dysreflexia in labor.

Pathophysiology

  • Occurs in 85% of women with spinal cord injury at level of T6 or above

  • When the woman experiences a painful stimulus below the level of the spinal injury (such as from contractions or even a full bladder), she may not be conscious of the pain but it is still perceived by the sympathetic nerve fibers

  • Because the sympathetic nerve fibers in the spinal cord are separated from their normal inhibition from the brain, the painful stimulus results in a hypersympathetic response ( Fig. 27.1 )

    Fig. 27.1, Spinal cord injury prevents descending regulation of efferent sympathetic spinal neurons. Therefore, noxious stimuli result in a reflexic hypersympathetic response.

  • This hypersympathetic response results in dangerously elevated blood pressure, cardiac arrhythmias, and other symptoms ( Fig. 27.2 )

    Fig. 27.2, Symptoms of autonomic dysreflexia.

    Technical and nontechnical skills for autonomic dysreflexia.

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