Can-SCIP Coach App
  1. Can-SCIP
  2. Recommendations
  3. Guidelines
  4. Section 2 - MANAGEMENT OF SCI COMPLICATIONS

J - AUTONOMIC DYSREFLEXIA (AD)




Prior to the procedure, counsel the individual to:

  1. Take prescribed medications (such as anticholinergic medications, alpha-blockers)
  2. Have a recent bowel program (within 1-2 days)
  3. Treat urinary tract infection, if present
  4. Hold any as-needed medications that may elevate blood pressure (such as ephedrine, midodrine)
  5. Hold any medications such as phosphodiesterase inhibitors (PDEis), which may not allow nitrates (nitropaste) to be used to treat autonomic dysreflexia
(PVA-AD 2020, p.643; Level C)
If prior to the procedure an individual presents with a systolic blood pressure that is greater than 20 mmHg above his or her usual baseline systolic blood pressure, evaluate for possible causes of autonomic dysreflexia and manage and monitor them. (PVA-AD 2020, p.643; Level C)
Consider rescheduling the individual’s procedure if autonomic dysreflexia persists despite finding and correcting any obvious reversible causes. (PVA-AD 2020, p.643; Level C)
Consider decreasing the risk of autonomic dysreflexia before urethral instrumentation, such as cystoscopy, by instilling lidocaine jelly into the urethra at least 3-5 minutes before urethral instrumentation. (PVA-AD 2020, p.643; Level C)
In individuals who are prone to autonomic dysreflexia or have a recent history of autonomic dysreflexia, consider prophylactic pharmacological treatment to decrease the risk of autonomic dysreflexia before cystoscopic procedures and sperm retrieval procedures. (PVA-AD 2020, p.643; Level C)
During sperm retrieval procedures, blood pressure should be monitored at 1-minute intervals. (PVA-AD 2020, p.643; Level C)
During cystoscopic and urodynamic procedures, monitor blood pressure in at least 2-minute intervals, preferably with an automatic blood pressure cuff. Perform more frequent blood pressure readings if the patient is developing autonomic dysreflexia during the procedure. (PVA-AD 2020, p.643; Level C)
Rather than immediately sitting an individual up during cystoscopic and urodynamic procedures, attempt to control autonomic dysreflexia by draining the bladder as needed, and, if not resolved, institute a similar pharmacological strategy as that recommended for the management of autonomic dysreflexia. (PVA-AD 2020, p.643; Level C)
During urological cystoscopic and urodynamic procedures, if autonomic dysreflexia is not controlled by draining the bladder or with pharmacological measures, stop the procedure and sit the individual up. (PVA-AD 2020, p.644; Level C)
Monitor blood pressure after a cystoscopic or urodynamic procedure or after ejaculation until it subsides to near the individual’s baseline. Monitor for continued elevated blood pressure or orthostatic hypotension when the individual is moved to the seated position. (PVA-AD 2020, p.644; Level C)
Autonomic dysreflexia prevention and control will be under the direction of the specialist administering anesthesia to individuals who require it while undergoing electroejaculation. (PVA-AD 2020, p.644; Level C)