From the Guidelines
Autonomic dysreflexia requires immediate termination of the triggering procedure, bladder drainage, and continued hemodynamic monitoring to prevent severe complications, as stated in the 2021 AUA/SUFU guideline 1. When managing autonomic dysreflexia, it is crucial to prioritize the patient's safety and prevent further complications. The condition is characterized by a sudden and dangerous spike in blood pressure, which can be triggered by various stimuli, including bladder distension, bowel impaction, skin irritation, tight clothing, or pressure sores. Symptoms of autonomic dysreflexia include severe headache, flushing above the injury level, sweating, nasal congestion, slow heart rate, and anxiety.
Key considerations in managing autonomic dysreflexia include:
- Immediate removal of the triggering stimulus
- Bladder drainage to relieve distension
- Continued hemodynamic monitoring to track blood pressure and other vital signs
- Administration of antihypertensive medications, such as nifedipine or nitroglycerin, if blood pressure remains elevated despite initial measures
- Escalation of care for patients with ongoing and persistent autonomic dysreflexia, as recommended in the 2021 AUA/SUFU guideline 1
In contrast to the initial recommendation to avoid pharmacologic management in patients with ongoing autonomic dysreflexia following bladder drainage, the most recent and highest-quality evidence suggests that immediate initiation of pharmacologic management and escalation of care is necessary for patients with persistent symptoms and elevated blood pressure 1. This approach prioritizes the patient's safety and well-being, reducing the risk of severe complications and improving outcomes.
From the Research
Definition and Causes of Autonomic Dysreflexia
- Autonomic dysreflexia (AD) is a life-threatening complication of spinal cord injury (SCI) at T6 or above, resulting in an uncontrolled sympathetic discharge in response to noxious stimuli 2.
- It is often secondary to urological, gastrointestinal, or gynecological problems or manipulations 2.
Symptoms of Autonomic Dysreflexia
- AD is characterized by a lethal rise in blood pressure with dangerous consequences, including severe paroxysmal hypertension, throbbing headaches, profuse sweating, nasal stuffiness, flushing of the skin above the level of the lesion, bradycardia, apprehension, and anxiety 3.
Management and Treatment of Autonomic Dysreflexia
- The key to effective management is prevention of the condition by recognition and avoidance of factors that initiate it 3.
- When AD occurs, immediate recognition and reversal of trigger factors along with prompt administration of pharmacological treatment is crucial to prevent complications 3.
- Captopril appears to be safe and effective for AD management, with a success rate of 80% in initial episodes and 94% in combined initial and repeat episodes 4.
- Nitroglycerin ointment is the most common first-line medication used by physicians in the US, while strong national differences exist in practice patterns 5.
- Other medications used for AD management include hydralazine, nifedipine, and immediate-release nifedipine 4, 5.
Importance of Prompt Recognition and Treatment
- Early recognition and prompt treatment of AD are vital to prevent complications, including death 2, 6.
- Delayed diagnosis and treatment can result in adverse outcomes, including mortality 3.
- It is essential for clinicians to have a basic understanding of the pathophysiology of AD and the simple steps required to treat it 6.