Clinical concerns for scleroderma and how I'd address them: Short answer, pt gets preinduction aline, and GA with ETT.
Airway- mouth opening likely limited, anticipate a challenging intubation. Consider AFOI if really concerned, modified RSI if not.
GI-clearly this pt has significant dysphagia is at a risk of aspirating into their already crappy lungs. With the diarrhea, the pt is volume down and SBP is going to tank with sedation/induction. Electrolytes are probably altered too. Give some IV volume and replete electrolytes to near normal levels prior to starting.
Pulm- restrictive and fibrotic lungs, with significant pathology evidenced by the severe pHtn. Room air Sats? Recent CXR? Any active pulmonary process that can be addressed prior to going to the OR? As previously mentioned, keep SBP>PASP. Avoid hypoxia/hypercarbia/acidemia...
CV-other than the terrible pulmonary hypertension likely secondary to the lung disease, can have restrictive pericardial disease and conduction abnormalities. What's the baseline activity status? Any recent EKG/echo?
Neuro- sensitive to NMB, no contraindication to sux as far as I know.
Some people may consider doing this case under mac/local but the risk of aspiration coupled with the poor lung function, and the severe pHtn that would only get worse if the pt starts desatting with the scope in, and the possible difficult airway lead me towards a GA.
I'd like to hear other thoughts and how the case went.
