© 2019 Jayme Schroeder
Blood pressure management in the acute period following spinal cord injury is a critical concern; one that anesthesia and critical care providers are often able to directly measure and regulate. It has been hypothesized that supraphysiologic blood pressure maintenance during this acute phase may improve recovery, however there is limited high-quality evidence to reinforce and guide management. Based on included prospective and retrospective studies, which provide the highest level of evidence available, The American Association of Neurologic Surgeons does provide the following level III recommendation: MAP goals of 85–90 mm Hg for 5–7 days post-injury should be considered. With regard to the optimal vasopressor, dopamine should be avoided. Norepinephrine should be considered as a first-line agent for cervical and upper thoracic spinal cord injuries, given evidence that it has a lower risk profile than dopamine. For injuries in the mid to lower thoracic spine, norepinephrine or phenylephrine should be considered as first-line agents. In summary, blood pressure management should not be overlooked and proper utilization could result in significant improvements in quality of life and hope for recovery.
Schroeder, Jayme, "Augmented Mean Arterial Blood Pressure And Vasopressor Selection In Patients With Spinal Cord Injury" (2019). Nurse Anesthesia Capstones. 25.