As a general rule I do value input from other specialists, but I'm still not really seeing what PMR is going to be able to tell me that I wouldn't get from a couple of basic directed questions to the patient, that would be relevant to my anesthetic.
Educate me ... what sort of things might you tell me that would make me alter my anesthetic plan?
I'm not trying to be rude, but I sort of suspect that the kind of input I'd get from PMR would be along the lines of cardiology telling me to avoid hypoxia and hypotension.
Edit - To be more specific, cardiology might do a surface echo or cath and give me data; they might recommend diuresis or other optimization for a CHF patient prior to surgery. What data and/or optimization will PMR provide or do that is important or useful to me?
It depends on how much you know. The OP expressed uncertainty about AD, difficulty of extubating an SCI patient, so that's an attending I would hope would consult us (formally or curbside). FPP kind of covered most of the relevant physio (AD minimized, but still a possible risk and prepare to deal with it, pt likely not to have intercostal innervation, watch the bladder, etc.). That's an attending I think we wouldn't be as concerned about coming up with their own plan. If you understand the basics of SCI physio, then we're unlikely to be changing your plan, but the OP and some other posters above didn't express a full understanding of SCI (which is understandable--many aren't dealing with SCI patients). An attending who doesn't understand AD (and that leg positioning can cause it, among many other things) is someone who doesn't know what they don't know, and ideally they should be touching base with us (or a more experienced colleague). We're the experts on AD--we manage it on our floor all the time. We're always happy to educate our colleagues on it (just as I'm sure you're happy to educate us if we don't understand your anesthetic plan-assuming you've got the free time!)
Knowing the patient's full ASIA classification (A, B, C, D, or E) is helpful (the OP only mentions their level)--a patient with a C6 ASIA D SCI may be walking and coughing just fine--no need to worry about AD, loss of intercostals/accessory muscles, etc.
Knowing the patient's extubation history is also important, and that may be something the patient remembers--if not, it's worth asking the patient's SCI physician (who's essentially their PCP), if they have a hx of difficult extubations, aspirations, etc. It may or may not change your plan, but it helps you be more prepared.
Typically most of the consults we get are from the surgeons planning the procedure. Occasionally we hear from anesthesia (like with a pregnant SCI patient), but usually by then we've already given our opinion, and often the anesthesiologist already knows what to do.
The main risks are respiratory compromise, and risk of AD (most often bowel/bladder, but can result from wounds, positioning, a folded sheet under the patient's skin, etc.) The surgery itself, in this case, won't cause AD as the noxious stimulus is above the level of injury, but there are still some things to be aware of. Many SCI patients will have baseline bradycardia and hypotension, so a patient's baseline SBP is in the 80's, the 120's is AD.
Short story, most of what we provide is education (we're not going to do any tests), which can help prevent complications, and we're happy to do that for any SCI patient of ours that a provider isn't sure about how to treat.
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