DOI: https://doi.org/10.14710/jai.v0i0.59220

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.
Open Access Copyright 2021 JAI (Jurnal Anestesiologi Indonesia)

Citation Format:
Cover Image
Abstract

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.

Note: This article has supplementary file(s).

Fulltext View|Download |  common.other
CTA
Subject
Type Other
  Download (763KB)    Indexing metadata
 Research Instrument
Graphical Abstract
Subject
Type Research Instrument
  View (344KB)    Indexing metadata
Keywords: cervical; hyperglycemia; intensive care unit; laminectomy; spinal cord injury

Article Metrics:

Article Info
Section: Case Reports
Language : EN
Recent articles
Dexmedetomidine Effects on Surgical Stress Hormones Risk Factors of Post Dural Puncture Headache in Cesarean Section Patients: A Multivariate Analysis Study The Effects of Dexmedetomidine As an Adjuvant with Levobupivacaine To Epidural Analgesia on The Outcomes of Patients Undergoing Total Abdominal Hysterectomy Surgery Anesthesia Management in Blalock-Taussig Shunt Procedure Anesthetic Management for Abdominal Aortic Aneurysm Rupture Anesthesia in A Patient with Pulmonary Atresia with Intact Ventricular Septum (PA IVS) Underwent Bidirectional Cavo-Pulmonary Shunt (BCPS) More recent articles
Most cited articles
Midazolam Intravena Dosis Rendah Tidak Mempengaruhi Nitric Oxide Intraperitoneal Mencit Balb/C Yang Terpapar Lipopolisakarida Patofisiologi Penyakit Jantung Koroner More cited articles
  1. Gede, I., SD., Agung, A., WPY . The Overview of Spinal Cord Injury. Ganesha Medicina Journal [Internet]. 2021 [cited 2023 July 17];103-13. E Pub 2021. Available from : https://ejournal.undiksha.ac.id
  2. Gondowardaja, Y., Eko, T. Trauma Medula Spinalis: Patobiologi dan Tata Laksana Medikamentosa. CDK-219 [Internet]. 2014 [cited 2023 July 17];567-71. E Pub 2021. Available from : https://www.neliti.com
  3. Martiana, I., Permana, D., Widhiyanto, L. Traumatic Cervikal Spinal Cord Injury. Is Urgent Intervention Superior to Delayed Intervention? A Meta-Analysis Evaluation. Journal Orthopaedi and Traumatology Surabaya Vol 8 No 1. [Internet]. 2019 [cited 2023 July 17];12-7. E Pub 2019. Available from : http://journal.unair.ac.id/ORTHO
  4. Arifin, M., Z., Henky, Jefry. Functional Independence Measure Penderita Cedera Servikal. MKB Vol.45 No.3. [Internet]. 2013[cited 2023 July 17];180-86. E Pub 2019. Available from : https://www.academia.edu
  5. Claxton, AR., Wong, DT., Chung, Frances., Fehlings, MG. Predictors of Hospital Mortality and Mechanical Ventilation in Patients with Cervical Spinal Cord Injury. Can J ANAESTH. [Internet]. 1998 [cited 2023 July 17];144-49. E Pub 2019. Available from : https://pubmed.ncbi.nlm.nih.gov
  6. Chang, JE., Park SH., Do, SH., Song, IA. Successful Weaning from Mechanical Ventilation in the Quadriplegia patient with C2 Spinal Cord Injury Undergoing C2-4 Spine Laminoplasty. The Korean Society of Anesthesiologists. [Internet]. 2013[cited 2023 July 17];545-9. E Pub 2013. Available from: : https://pubmed.ncbi.nlm.nih.gov
  7. Sanfilippo, F., Falco, DD., Noto, A., Santonocito, C., Morelli, A., Bigmani, E., Scolletta, S., Baron, AV., Astuto, M. Respiration and The Airway. Association of Weaning Failure from Mechanical Ventilation with Transthoracic Echocardiography Parameters : A systemic Review and Meta Analysis. British Journal of Anaesthesia. [Internet]. 2020 [cited 2023 July 17];319-29. E Pub 2020. Available from: https://europepmc.org
  8. Moon, AS., Pearson, JM., Pittman, JL. Phrenic Nerve Palsy After Cervical Laminectomy and Fusion. North Amercan Spine Journal (NASSJ). [Internet]. 2020 [cited 2023 July 17]. E Pub 2020. Available from: https://pubmed.ncbi.nlm.nih.gov
  9. Badice, RK., Mayer, R., Pennicooke, B., Chou, D., Mummaneni, PV., Tan, LA. Complication Following Posterior Cervical Decompression and Fusion : A Review of Incidence, Risk Factor, and Prevention Strategies. Journal of Spine Surgery. [Internet]. 2020 [cited 2023 July 17];323-33. E Pub 2020. Available from: https://pubmed.ncbi.nlm.nih.gov
  10. Sampol, J., et all. Predictor of Respiratory Complication in Patients with C5-T5 Spinal Cord Injuries. Springer Nature. [Internet]. 2020 [cited 2023 July 17];1249-53. E Pub 2020. Available from: https://www.nature.com
  11. Putri, A., Akbar SN., Fauzia, R. Gambaran Optimisme pada Pasien Spinal Cord Injury. Jurnal Kognisia. 2018 [cited 2023 July 17];15-20. E Pub 2020. Available from: https://ppjp.ulm.ac.id
  12. Pande, R., Maurya, V.Ventilator-Associated Pneumonia . ICU Protocols Second Editions. Singapore : Springer. 2020 ; 1 (13) : 119-27
  13. Arora, S. , Oliver, F. Spinal Injuries. OH’s Intensive Care Manual Eight Edition. China: Elsevier. 2019 ; 11 (80) : 938-50
  14. Clouser, R.Weaning from Mechanical Ventilation, and Extubation . Critical Care Secrets Sixth Edition. Philadelphia : Elsevier. 2019; 1 (10): 65-9
  15. Atmadja, A.,S., Sekeon, S., Ngantung, D. Diagnosis and treatment of Traumatic Spinal Cord Injury. Jurnal Sinaps.[Internet]. 2020 [cited 2023 Nov 10] Vol(1);25-35. E Pub 2021. Available from: https://jurnalsinaps.com
  16. Furlan, J. Effects on Outcomes of Hypergycemia in the Hyperacute Stage after Acute Traumatic Spinal Cord Injury. Neuro Trauma Report.[Internet]. 2021 [cited 2023 Nov 10] Vol(2):1;25-35. E Pub 2021. Available from: DOI : 10.1089/neur.2020.0042
  17. Bennett, J., Das., Emmady, P. Spinal Sord Injury. StatPearls. .[Internet]. 2022 [cited 2023 Nov 10] E Pub 2021. Available from: https://pubmed.ncbi.nlm.nih.gov
  18. Alizadeh, A., Dyck, S., Abdolrezaee, S. Traumatic Spinal Cord Injury : An Overview of Pathophysiology, Models and Acute Injury Mechanism. Frintiers in Neurology.[Internet]. 2021 [cited 2023 Nov 10] Vol(10):282;1255. E Pub 2021. Available from: DOI : 10.3389/fneur.2019.00282
  19. Hellenbrand, D., Quinn, C., Piper, Z., Morehouse, C., Fixel, J., Hanna, A. Inflammation after Spinal Cord Injury: A Review of the Critical Timeline of Signaling Cues and Cellular Infiltration. Journal of Neuroinflammation. [Internet]. 2021 [cited 2023 Nov 10] Vol(18):284;1-16 . E Pub 2021. Available from: https://doi.org/10.1186/s12974-021-02337-2
  20. Hill, M., Jorgensen, S., Engstrom, G., Persson, M., Lexell, J. Functional and Structural Impairment of the Pulmonary System in Middle-aged People with Cervical and Upper Thoracic Spinal cord Injuries.The Journal of Spinal Cord Medicine. [Internet]. 2023 [cited 2023 Nov 10] Vol 46:2; 732-741. E Pub 2021. Available from: https://doi.org/10.1080/10790268.2022.2031478
  21. Ding, W., Hu, S., Wang, P., Kang, H., Peng, R., Dong, Y., Li, F. Spinal Cord Injury: The Global Incidence, Prevalence, and Disability From the Global Burden of Disease Stydy 2019. SPINE. [Internet]. 2022 [cited 2023 Nov 10] Vol 47:21; 1532-1540. E Pub 2021. Available from: DOI: 10.1097/BRS.0000000000004417
  22. Ziu, E., Mesfin, F. Spinal Shock. StatPearls. [Internet]. 2022 [cited 2023 Nov 10] Vol 47:21; 1532-1540. E Pub 2022. Available from: https://pubmed.ncbi.nlm.nih.gov
  23. Basuki, W., Bisri, D., Saleh, S., Wargahadibrata. Pengelolaan Perioperatif Cedera Medula Spinalis Servikal Karena Trauma dengan Tetraparese Francle C Asia. Jurnal Neuroanestesi Indonesia. [Internet]. 2022 [cited 2023 Nov 10] Vol 7:1; 28-35. E Pub 2018. Available from DOI: 10.24244/jni.vol7i1.24
  24. Druschel, C., Ossami, R., Grittner, U., Nowak, C., Meisel, A., Dieter, K., Niedeggen, A., Liebscher, T., Kopp, M. Clinical Decision- Making on Spinal Cord Injury Associated Pneumonia: A Nationalwide Survey in Germany. Spinal Cord. [Internet]. 2020 [cited 2023 Nov 10] Vol 58; 873-81. E Pub 2020. Available from: https://doi.org/10.1038/s41393-020-0435-5

Last update:

No citation recorded.

Last update: 2025-04-03 14:04:36

No citation recorded.