Cardiovascular management of neurogenic shock

Neurogenic shock results from acute spinal cord injury, affecting both sensory and motor conduction at the cervical and upper thoracic levels. This leads to hemodynamic alterations characterized by hypotension, bradycardia, and other autonomic dysreflexias due to the loss of sympathetic tone. This condition is associated with high morbidity and often necessitates surgical intervention, requiring a multidisciplinary approach and posing a challenge for anesthesiologists in perioperative management. The primary treatment goals are neuroprotection, neuroregeneration, and the prevention of secondary injury. Management begins with a thorough preoperative evaluation, including airway management planning, induction strategies that preserve hemodynamic stability, fluid resuscitation, anticipation of potential bleeding risks, and the administration of vasopressor agents and blood products.