الفهرس 
Pathophysiology of Traumatic Spinal cord injuryOnly 14 pages are availabe for public view
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Abstract
Anesthesiologists are often involved in the initial resuscitation and management of trauma victims especially those with possible cervical spine injuries. So the first step to deal with spinal cord injury is under standing the patho-physiology of the spinal cord injuries that include; phases of pinal cord injury and pathological changes occure at every phase and how it is presented clinically then knowing the approach for classification of SCI.
Also in discussing patho-physiolgy of SCI to was important to focus on systemic effect of spinal cord injury that affect most of body system depending on level of lesion; cardiovascular system, respiratory, muscular changes and it’s relation to muscle relaxants, gastrointestinal tract and urinary tract.
Pre-anesthetic evaluation should be done prior to any anesthetic management of patients with SCI. It is depend on neurological assessment through determination of motor, sensory and if the lesion is complete or incomplete. After neurological assessment the time clarify cervical spine stability mainly by radiological method or -to lesser extent- by some clinical criteria and there is certain condition recuiring urgent oro-tracheal intubation without delay.
Anesthetic management should be devised with particular attention to; the effect of basic airway maneuvers on mobility of the cervical spine mobility and different method that can be used for securing the airway. Oro-tracheal intubation under general anesthesia with manual inline traction is considered the best method.
Patients with acute SCI undergoing surgery will almost universally require general anesthesia. Spot light was done on intra-operative anesthetic management through; selection of anesthetic agent, muscle relaxant, hemodynamic management as hypotension, hypertension and hyperglycemia should be avoided during anesthesia with careful positioning of patients as quadriplegic patients poorly tolerate acute positional changes. All drugs should be given slowly by titration because of the cardiovascular liability with monitoring of spinal cord especially with incomplete injuries.
Most of patients with acute cord injuries who have such unstable cardiovascular and respiratory status should not be extubated at the end of the surgical procedure. Instead they should be transferred directly to an intensive care unit for further care. Critical care unit may be the first place for patient with SCI and it may be postoperative place so critical care management will include; neurological assessment and clarifying stability of cervical spine as mentioned before.
Immobilization of injured spine, securing airway especially in some patient with impaired level of consciousness, Respiratory management and need for mechanical ventilation are corner stones at critical care associated with cardiovascular and haemodynamic monitoring with attention to need for haemodynamic support or not.
Critical management of SCI is directed towards limiting secondary injury and maximizing neurologic recovery. This may be achieved surgically by relieving or preventing compression of neural structures and other methods either pharmacological or non pharmacological for optimizing cord perfusion and oxygenation and disrupting cell injury mechanisms.
Also Insisting on preventing complications like infection by aggressive care of lung, bladder, and skin, prophylaxis against DVT and stress ulcers. Finally it is important to start rehabilitation as soon as possible.