Perioperative management of hypotension in traumatic cervical spinal cord injury: a case study and clinical insights
Abstract
Introduction: Traumatic cervical spinal cord injury (SCI) is often complicated by neurogenic hypotension, which exacerbates secondary injury. This case is unique due to a 10-hour delayed presentation without prehospital care, successful use of dual vasopressors (norepinephrine + dopamine) in a resource-limited setting, and neurological stabilization despite initial MAP of 54 mmHg. Guidelines recommend maintaining MAP >85 mmHg for 7 days.
Case Description: This report describes a 57-year-old male presented 10 hours after a collapsing structure injury with ASIA Impairment Scale C tetraparesis, complete lower limb paralysis, absent sacral sparing, and MAP 54 mmHg. Haemodynamic support with norepinephrine (0.02 mcg/kg/min) and dopamine (1 mcg/kg/min) elevated MAP to >85 mmHg. Diagnostic magnetic resonance imaging (MRI) revealed disc protrusions at C3-6 with spinal cord edema. The patient underwent elective Anterior Cervical Discectomy and Fusion (ACDF) under neuroanesthesia, with induction using fentanyl, propofol, and rocuronium. Intraoperative stability was maintained (MAP 87–90 mmHg), and postoperative care included vasopressor tapering by day 3, with a stable ASIA scale C and no further neurological worsening.
Conclusion: This case emphasizes the critical role of early aggressive hypotension management in SCI to preserve neurological functions. Targeting MAP >85 mmHg using vasoactive agents and surgical intervention prevents secondary injury, highlighting a multidisciplinary approach for optimal outcomes in traumatic cervical SCI.
Keywords: Hypotension, traumatic spinal cord injury, tetraplegia, perioperative management, neurogenic shock
Citation: Lesmana MWS, Rahardjo S, Faudi I, Rahman IA. Perioperative management of hypotension in traumatic cervical spinal cord injury: a case study and clinical insights. Anaesth. pain intensive care 2025;30(1):114-119. DOI: 10.35975/apic.v30i1.3089
Received: November 10, 2025; Revised: December 10, 2024; Accepted: December 16, 2025
