Anesthésie du blessé médullaire en chirurgie urologique

Voiding dysfunctions are almost always present after a spinal cord injury. The aim of the urologic management is to avoid upper urinary tract damage and to improve patients' quality of life. Although sensibility may be absent of the surgical field, specific circulatory and respiratory changes due to the spinal lesion deserved an adapted anaesthesiology management. Autonomic dysreflexia represents a major risk since consequences may be life threatening. Spasticity, impaired bowel motility, skin fragility need also to be taken in count. All types of anesthesia (local, loco-regional and general) are feasible but spinal anaesthesia presents appealing advantages when possible. The choice of a technique is primarily made upon the level and completeness of injury, the type of surgery, the presence of autonomic dysreflexia history and the patient's preference.