A Systematic Review of the Management of Autonomic Dysreflexia Following Spinal Cord Injury

Autonomic dysreflexia (AD) is a clinical emergency in individuals with spinal cord injury (SCI), particularly at or above T6. It involves acute elevation of blood pressure and either slow or rapid heart rate. The review examines strategies to prevent and manage AD, including both pharmacological and non-pharmacological interventions. The initial non-pharmacological management includes positioning the patient upright, loosening tight clothing, and eliminating any precipitating stimulus. When non-pharmacological measures fail and systolic blood pressure remains elevated, antihypertensive drugs may be used. A variety of preventative and management options exist, but are predominantly supported by evidence from non-controlled trials.

• 1
  Preventative strategies for AD triggered by common stimuli (e.g., urogenital system) are primarily supported by Level 4 and Level 5 evidence.
• 2
  Initial acute non-pharmacological management of AD is supported by clinical consensus and physiological data (Level 5 evidence).
• 3
  Antihypertensive drugs are supported by Level 1 (prazosin) and Level 2 evidence (nifedipine and prostaglandin E2) in the presence of sustained elevated blood pressure.