Autonomic hyperreflexia in spinal cord lesion is due to interruption of inhbitory im from higher centers. Especially, dramatic disturbance is seen in cord lesions above the fifth thoracic se and consist of hypertension, bradycardia and sweating. Sometimes marked hypert results in fatal cerebral hemorrhage or subarachnoid hemorrhage ao that the anesthesic gets used to its control and treatment. In current methods of control of hypertension, there are general anesthesia with halothane or enflurane, spinal anesthesia and ganglionic blockers. Ganglionic blockers, such as hexamethonium, drsmatically suppress marked arterial hypertension, also. We have experienced 3 cases of tetraplegic patients. Two cases given local anesthesia developed autonomic hyperreflexia but one case given general anesthesia did not have the hyperreflexia.
Anesthesia, General ; Anesthesia, Local ; Anesthesia, Spinal ; Autonomic Dysreflexia* ; Bradycardia ; Cerebral Hemorrhage ; Enflurane ; Ganglionic Blockers ; Halothane ; Hexamethonium ; Humans ; Hypertension ; Reflex, Abnormal ; Spinal Cord ; Subarachnoid Hemorrhage ; Sweat ; Sweating

Early correction of congenital cardiac defects has been facilitated by the use of deep hypothermia and cardiorespiratory arrest. Simple deep hypothermia has a number of advantages for infant open heart surgery, such as a quiet heart and bloodless operative field, reduced blood requirement, elimination of pulmonary and coagulation problems following cardiopulmonary bypass, elimination of cannulation, simple anesthetic technique, no neccessity of complicated facilities, and stable postoperative course. Deep ether anesthesia is the ideal agent for induction of deep hypothermia by surface cooling, especially when combined with ganglionic blocking agents in large quantities to elimiminate some of the undesirable effects of ether, thus improving and maintaining good peripheral perfusion. We have performed a total correction of TOF on March, 1979. Anesthesia was induced with intravenous thiopental and succinylcholine for intubation and maintained by a tight closed circuit system with ether. As soon as routine EKG, direct intra-arterial pressure, esophageal and rectal temperature monitoring devices were installed, slow intravenous administration of triflupromazine was followed by surface cooling. Surface cooling was done by the technique of covering the child with bags of crushed ice after placing the infant on an ice water blanket. After cooling, the intracardiac procedure was performed under circulatory occlusion and cardiac arrest, following cardioplegic infusion, for 45 minutes. After the intracardiac procedure, cardiac resuscitation and rewarming were accomplished by cardiopulmonary bypass technique. The patient recovered satisfactorily and was discharged on POD14 without any complication.
Administration, Intravenous ; Anesthesia ; Cardiopulmonary Bypass ; Catheterization ; Child ; Electrocardiography ; Ether ; Ganglionic Blockers ; Heart ; Heart Arrest ; Humans ; Hypothermia* ; Ice ; Infant ; Intubation ; Perfusion ; Resuscitation ; Rewarming ; Succinylcholine ; Tetralogy of Fallot* ; Thiopental ; Thoracic Surgery ; Triflupromazine ; Water