Anesteziologický postup a perioperační péčeu sakrální deaferentace (SDAF) a elektrostimulacemočového měchýře (SARS) u pacientů s kompletnítransverzální míšní lézí

Technique of Anaesthesia and Perioperative Care in Sacral Deafferentation (SDAF) and Electrostimulationof Urinary Bladder (SARS) in Patients with Transversal Spinal Cord Lesions

Transversal spinal cord lesions are among the most serious consequences of severe spinal injuries. Approximately 85% ofpatients who survived the first year after injury would die due to urological complications. They have a significantlyshortened average life span.Sacral deafferentation accompanied by implantation of a sacral anterior root stimulator which restores the patients´ abilityto control micturition, defaecation and erection is a newand very effective method of treatment of these patients.Theauthorsdescribe both the specific technique of anaesthesia and basic principles of perioperative care associated with this procedurewhich was carried out for the first time in an Eastern European country. The procedure is performed in an extreme proneposition and controlled hypotension is essential. Restriction of fluids, anaesthesia with a limited administration ofneuromuscular blocking agents and the participation of an anaesthetist differentiating both the anterior and posterior spinalcord roots are further specific features of this procedure. The authors also present results of surgery of first six patientswho underwent surgery in the University Hospital Brno from January to September 2001.

Key words:
sacral deafferentation – implantation of a sacral anterior root stimulator – anaesthesiological technique –controlled hypotension