Acta Scientific Medical Sciences (ASMS)(ISSN: 2582-0931)

Research Article Volume 6 Issue 3

Place of Atropine and Vasoactive Drugs in Hemodynamic and Rhythmic Complications of Cervical Spine Trauma

SM Medjadi1*, L Cherfi2, H Brahimi3 and N Taleb Bendiab4

1Department of Anesthesia and Intensive Care, Aboubekr Belkaïd University, Tlemcen, Algeria
2Department of Anesthesia and Intensive Care, Hospital Center Henri Mondor, Aurillac, France
3Department of Infectious Diseases, Aboubekr Belkaïd University, Tlemcen, Algeria
4Department of Cardiology, Aboubekr Belkaïd University, Tlemcen, Algeria

*Corresponding Author: SM Medjadi, Department of Anesthesia and Intensive Care, Aboubekr Belkaïd University, Tlemcen, Algeria.

Received: December 09, 2021; Published: February 15, 2022

Abstract

Objectives: The aim of this work is to demonstrate the importance of the earliest atropine’s introduction and vasoactive drugs as preventive therapy for the occurrence of hemodynamic and rhythmic complications, which most often severely hamper the prognosis of cervical spine trauma patients.

Patients and Methods: Exhaustive descriptive-type study with prospective collection, carried out over a period of three and a half years at the level of several structures of the Tlemcen University Hospital, namely medico-surgical emergencies, multipurpose resuscitation and neurosurgery departments. It focuses on cervical spine trauma patients treated from the scene of the accident to the neurosurgery and/or medico-surgical intensive care unit at Tlemcen University Hospital. All were admitted for cervical spine trauma, whatever the level reached, whatever the mechanism of the accident, whatever the treatment decision, with or without neurological lesions, with or without signs of seriousness on admission and over 16 years of age.

Results: The initial management in intensive care and in a dechocking unit for vegetative disorders was indicated on admission in 25% of patients. Cardiac arrest recovered in three patients on admission to medico-surgical emergencies. An injection of Atropine® on admission was performed in 18.75% of patients, but also vasoconstrictor drugs in 15.62%. A combination of vasoactive drugs and Atropine® were required in 7.81% of our patients; 33 of them had hemodynamic disturbances and 20 were in collapse requiring the use of vasoconstrictor drugs.

Conclusion: Our study allowed us to study and analyze the main hemodynamic and rhythmic changes occurring during cervical spine trauma. Survival was 7 ± 3.71 days for the patients who had bradycardia, and 29 ± 6.13 days for those who had kept a normal heart rhythm (P = 0.000). Maintaining a stable heart rate and hemodynamic state upon admission remains the primary care physician's priority in order to increase the chances of survival for this type of patient.

Keywords: Cervical Spine Trauma; Neurogenic Shock; Atropine; Vasoactive Drugs; Hemodynamic Complications

References

  1. B Bussel., et al. “Les tétraplégiques par lésions médullaires, actes des 14e entretiens de l’Institut Garches”. (Editions Roche) (2001).
  2. Guly H., et al. “The incidence of neurogenic shock in patients with isolated spinal cord injury in the emergency department”. Resuscitation 1 (2008): 57-62.
  3. Claydon V., et al. “Orthostatic hypotension following spinal cord injury: understanding clinical pathophysiology”. Spinal Cord6 (2006): 341.
  4. DeVivo MJ., et al. “Recent trends in mortality and causes of death among persons with spinal cord injury”. Archives of Physical Medicine and Rehabilitation11 (1999): 1411-1419.
  5. Garshick E., et al. “A prospective assessment of mortality in chronic spinal cord injury”. Spinal Cord7 (2005): 408.
  6. Raw D., et al. “Anaesthesia for spinal surgery in adults”. British Journal of Anaesthesia6 (2003): 886-904.
  7. M N Hadley., et al. “Blood pressure management after acute spinal cord injury”. Neurosurgery 50 (200): S58-S62.
  8. Stratman RC., et al. “Hemodynamic management after spinal cord injury”. Orthopedics3 (2008).
  9. Lehmann KG., et al. “Cardiovascular abnormalities accompanying acute spinal cord injury in humans: incidence, time course and severity”. Journal of the American College of Cardiology 1 (1987): 46-52.
  10. PIEPMEIER JM., et al. “Cardiovascular instability following acute cervical spinal cord trauma”. Central Nervous System Trauma3 (1985): 153-160.
  11. Levi L., et al. “Hemodynamic parameters in patients with acute cervical cord trauma: description, intervention, and prediction of outcome”. Neurosurgery6 (1993): 1007-1017.
  12. Habbab Adil. “Prise en charge du rachis cervical traumatique en milieu de réanimation chirurgicale à l’hôpital militaire Avicenne- Marrakech à propos de 20 cas” (2016).
  13. Inoue T., et al. “Medical and surgical management after spinal cord injury: vasopressor usage, early surgerys, and complications”. Journal of Neurotrauma3 (2014): 284-291.
  14. McKinley W., et al. “Cardiovascular concerns in spinal cord injury. eMedicine eMedicine Specialties/Physical Medicine and Rehabilitation”. Spinal Cord Injury (2006).
  15. Bilello JF., et al. “Cervical spinal cord injury and the need for cardiovascular intervention”. Archives of Surgery10 (2003): 1127-1129.
  16. Frankel H., et al. “Mechanisms of reflex cardiac arrest in tetraplegic patients”. The Lancet7946 (1975): 1183-1185.
  17. Vale FL., et al. “Combined medical and surgical treatment after acute spinal cord injury: results of a prospective pilot study to assess the merits of aggressive medical resuscitation and blood pressure management”. Journal of Neurosurgery2 (1997): 239-246.
  18. Ploumis A., et al. “A systematic review of the evidence supporting a role for vasopressor support in acute SCI”. Spinal Cord5 (2010): 356.
  19. Consortium for Spinal Cord Medicine. “Early acute management in adults with spinal cord injury: a clinical practice guideline for health-care professionals: paralyzed veterans of America”. The Journal of Spinal Cord Medicine (2008): 403-479.
  20. Dumont RJ., et al. “Acute spinal cord injury, part I: pathophysiologic mechanisms”. Clinical Neuropharmacology5 (2001): 254-264.
  21. Wu JC., et al. “Risque accru d'accident vasculaire cérébral après une lésion de la moelle épinière : une étude de cohorte de suivi nationale de quatre ans”. Neurologie 78 (2012): 1051-1057.
  22. Dumont RJ., et al. “Acute spinal cord injury, part II: contemporary pharmacotherapy”. Clinical Neuropharmacology5 (2001): 265-279.
  23. Yashon D., et al. “Edema of the spinal cord following experimental impact trauma”. Journal of Neurosurgery6 (1973): 693-697.
  24. Ducker TB., et al. “Recovery from spinal cord injury”. Clinical Neurosurgery 30 (1983): 495-513.

Citation

Citation: SM Medjadi., et al. “Place of Atropine and Vasoactive Drugs in Hemodynamic and Rhythmic Complications of Cervical Spine Trauma”.Acta Scientific Medical Sciences 6.3 (2022): 76-82.

Copyright

Copyright: © 2022 SM Medjadi., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.




Metrics

Acceptance rate30%
Acceptance to publication20-30 days
Impact Factor1.403

Indexed In





Contact US