Journal CME, December 2023: Autonomic dysreflexia: Current pharmacologic management-Journal CME, December 2023: Autonomic dysreflexia: Current pharmacologic management

Journal CME, December 2023: Autonomic dysreflexia: Current pharmacologic management

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Autonomic dysreflexia (AD) is a potentially dangerous complication of spinal cord injury (SCI) that results in a sudden increase in blood pressure. A study conducted by Ryan Solinsky and his team aimed to determine the current pharmacologic management practices for AD among physicians throughout the Americas. They surveyed 60 physicians who manage patients with SCI and prescribe medications for AD. The study found that the majority of physicians (69%) had a formal AD management protocol for inpatient care, with the most common first-line medication being nitroglycerin ointment (82%).<br /><br />However, the study also revealed significant national differences in practice patterns. While 98% of U.S.-based physicians used nitroglycerin ointment as the first-line medication, none of the physicians in Canada or Latin America used this medication due to its unavailability. Instead, physicians in these regions relied on alternative medications such as nifedipine, captopril, amlodipine, and carvedilol.<br /><br />The study also found that only 67% of physicians had a preferred second-line medication, with hydralazine and nifedipine being the most commonly used. Additionally, 56% of physicians used a systolic blood pressure threshold to initiate medication management, while 26% considered the neurological level of injury in their decisions.<br /><br />In conclusion, U.S.-based physicians caring for individuals with SCI largely have formal protocols for medication management of AD, with nitroglycerin ointment being the most commonly used first-line medication. However, practice patterns significantly differ in regions where nitroglycerin ointment is unavailable. This study highlights the need for improved availability of medications and the importance of further research to guide the management of AD.

Keywords

autonomic dysreflexia

spinal cord injury

blood pressure

pharmacologic management

physicians

nitroglycerin ointment

national differences

alternative medications

systolic blood pressure threshold

medication management