A 35-year-old woman with a T4 spinal cord injury is undergoing colorectal surgery. Which of the following signs would most likely indicate intraoperative autonomic dysreflexia in this patient?

Autonomic dysreflexia (also called autonomic hyperreflexia) can be seen in patients with a spinal cord injury at T6 or above. It is estimated that two-thirds of patients with this level of spinal cord injury are at risk for autonomic dysreflexia (AD).

Unopposed sympathetic efferent outflow is triggered by noxious afferent input (such as pain) from below the level of the spinal cord injury, which results in the signs and symptoms of AD (Figure 1). In a patient without spinal cord injury, an inhibitory signal (traveling through the intact spinal cord) would occur in response to this, preventing AD. This pathway is blocked in spinal cord injury.

Frequently, pelvic visceral...

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