One hour after a motor vehicle accident with C7 spinal cord transection and ruptured spleen, regarding neurologic injury, which anesthetic concern is correct?

One hour after a motor vehicle accident with C7 spinal cord transection and ruptured spleen, regarding neurologic injury, which anesthetic concern is correct?

• A. Risk of hyperkalemia with succinylcholine administration
• B. Risk of autonomic hyperreflexia with urinary catheter insertion
• C. Need for fiberoptic intubation
• D. Increased risk of hypothermia

Answer: (D)

The key idea is that an acute cervical spinal cord injury disrupts automatic temperature regulation. When the sympathetic pathways below the level of injury are interrupted, the body can’t properly conserve heat: there’s cutaneous vasodilation below the lesion, leading to greater heat loss, and the patient’s ability to generate heat by shivering is impaired. Under anesthesia, exposed tissues, cold operating room environments, and administration of IV fluids and anesthetic agents can exacerbate this heat loss, making hypothermia a common and important risk in the perioperative period after a high cervical injury. That’s why increased risk of hypothermia is the best answer here. Succinylcholine hyperkalemia becomes a concern only after the first day or two when nicotinic acetylcholine receptors are upregulated in denervated muscle, so it’s not a correct early concern. Autonomic hyperreflexia typically requires time after injury to develop and is commonly triggered by bladder or bowel issues in the subacute phase, not the immediate hour after injury. Fiberoptic intubation isn’t indicated by the spinal injury alone in this scenario without airway difficulty.

The key idea is that an acute cervical spinal cord injury disrupts automatic temperature regulation. When the sympathetic pathways below the level of injury are interrupted, the body can’t properly conserve heat: there’s cutaneous vasodilation below the lesion, leading to greater heat loss, and the patient’s ability to generate heat by shivering is impaired. Under anesthesia, exposed tissues, cold operating room environments, and administration of IV fluids and anesthetic agents can exacerbate this heat loss, making hypothermia a common and important risk in the perioperative period after a high cervical injury.

That’s why increased risk of hypothermia is the best answer here. Succinylcholine hyperkalemia becomes a concern only after the first day or two when nicotinic acetylcholine receptors are upregulated in denervated muscle, so it’s not a correct early concern. Autonomic hyperreflexia typically requires time after injury to develop and is commonly triggered by bladder or bowel issues in the subacute phase, not the immediate hour after injury. Fiberoptic intubation isn’t indicated by the spinal injury alone in this scenario without airway difficulty.