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Management of Patients Post Laminectomy Decompression Et Causa Spinal Cord Injury Cervical Vertebrae 1-7 with Hyperglikemia in Intensive Care Unit

1Faculty of Medicine, Public Health and Nursing, Gadjah Mada University/RSUP Dr. Sardjito, Yogyakarta, Indonesia

2Department of Anesthesia and Intensive Care, Faculty of Medicine, Public Health and Nursing, Gadjah Mada University/RSUP Dr. Sardjito, Yogyakarta, Indonesia

3Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Diponegoro University/RSUP Dr. Kariadi, Semarang, Indonesia

Received: 28 Oct 2023; Revised: 14 Feb 2024; Accepted: 19 Feb 2024; Published: 31 Mar 2024.

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Background: In the United States, in 2008 of 100,000 cases of spinal cord injury, 2/3 were cases of cervical injury. Patients who experience cervical to thoracic Spinal Cord Injury (SCI) above T8, usually have impaired function of the diaphragm and intercostal muscles which causes respiratory failure. Neurogenic shock occurs in patients who experience SCI above T6 which causes vasodilation, hypotension and severe bradycardia or asystole when stimulating vagal reflexes such as laryngoscopy or suctioning.

Case: The patient was diagnosed with SCI cervical vertebrae 1-7. The patient underwent decompressive laminectomy et causa SCI cervical vertebrae 1-7 and hyperglycemia. Management includes surgical therapy, management of respiratory failure in the Intensive Care Unit (ICU), pharmacological therapy include insulin for hyperglicemia control, and support for neurogenic shock and physioterapy.

Discussion: Patients with SCI require laminectomy, supportive therapy, pharmacotherapy include insulin, neurogenic shock, and respiratory support if there is respiratory failure. In cases of injury to cervical vertebrae 1-7, the patient requires ventilator support to assist the function of the diaphragm and intercostal muscles, pharmacological supportive therapy for neurogenic shock, as well as care from a sub-endocrine specialist to treat hyperglycemia. Stress-induced hyperglycemia was occurred due to CNS injury.

Conclusion: Spinal Cord Injury (SCI) is a disorder of the spinal cord or spinal cord with neurological symptoms ranging from motor, sensory and autonomic function.  Respiratory failure in SCI above thoracic 8, is due to disturbances in the function of the diaphragm and intercostal muscles. The occurrence of neurogenic shock in SCI cases, especially above thoracic 6, manifests in the form of vasodilation, hypotension and severe bradycardia or asystole. Management in the ICU includes hemodynamic monitoring, respiratory failure, prevention of neurogenic shock, and pharmacology to treat hyperglycemia. Biochemical parameters, nutritional status, and respiratory function were also monitored.

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Keywords: cervical; hyperglycemia; intensive care unit; laminectomy; spinal cord injury

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