The number of patients with autonomic hyperreflexia returning for various surgeries is increasing due to improved medical management of urinary tract and respiratory tract complications in patients with spinal cord injury. This chapter presents a case study of a 44-year-old male who sustained a motor vehicle accident 6 years previously that resulted in paraplegia secondary to T6 spinal cord injury. The surgery was performed under the block and light sedation using midazolam without any complications or significant hemodynamic perturbations. Spinal cord injuries can be caused by either traumatic or nontraumatic causes. Most of these patients survive to return for elective surgeries, most commonly urological and orthopedic procedures. General anesthesia can be employed while maintaining adequate depth using potent volatile anesthetic, narcotics, and systemic sympatholytics to decrease the afferent sensory discharge. Perioperative management of these patients requires knowledge of the risks associated with this phenomenon as well as the pathophysiology.