There is increase in number of patients with spinal cord injury presenting for surgery or obstetric care In the acute phase of SCI, anesthesiologists provide emergency cardiovascular, respiratory management and general anesthesia for surgery involving an associated injury and anesthesia for stabilization and decompression laminectomy. Acute spinal cord injury causes unique pathophysiological changes including cardiovascular and respiratory compromise, which have serious implication in anesthetic management. The most important perioprative danger of chronic spinal cord injury are : autonomic hyperreflexia, bradycardia, hypotension, respiratory inadequacy and muscle spasm. Autonomic hyperreflexia my be precipitated by surgery or bladder distension. General anesthesia of sufficient depth is effective at controlling autonomic hyperreflexia and muscle spasm but hypotension and is a risk. There is a growing consensus that spinal anesthesia is safe, effective, and technically simple to perform in some patient with chronic spinal cord injury. Epidural anesthesia may be used in obstetric patients