Ra

[Varmit22]

Advertisement - Members don't see this ad

Anyone know of good articles dealing with the perioperative management of rheumatoid arthritis? Thanks.

 

[Gern Blansten]

Stoelting's Anesthesia and Coexisting Disease will probably get >95% of what you need to know.

 

[Gasboy07]

I'll have a look at my copy of Fleisher when I get home and find some references... here's a summary from anaesthesia uk

Airway

* Involvement of temporomandibular joints
* Cervical spine fixed/subluxed and therefore can be unstable
* Cricoarytenoid involvement should be suspected if hoarse voice present

Respiratory system

* Costochondral involvement may cause a restrictive deficit and decreased tidal volume
* Interstitial fibrosis can cause a V/Q mismatch

Cardiovascular system

* Coronary arteritis
* Conduction abnormalities
* Immobility may obscure underlying symptoms of cardiovascular system disease

Anaemia

* Chronic anaemia often present
* Treatment with non-steroidal anti-inflammatory drugs can cause gastrointestinal blood loss

Renal failure

* May be caused by amyloidosis or chronic drug treatment

Steroid therapy

* Steroid cover needed
* Postoperative infection can occur

Investigations

* Full blood count, urea & electrolytes, chest X-ray, cervical spine X-ray, ECG, pulmonary function in some cases

Conduct of anaesthesia

* Careful positioning
* Difficult intubation set ready
* Awake fibreoptic if necessary
* Regional blockade preferable

 

[EtherMD]

Ra - Egyptian Solar Deity. Also, a powerful Goauld in a Sci-Fi TV series.

 

[johankriek]

I'll have a look at my copy of Fleisher when I get home and find some references... here's a summary from anaesthesia uk

Airway

* Involvement of temporomandibular joints
* Cervical spine fixed/subluxed and therefore can be unstable
* Cricoarytenoid involvement should be suspected if hoarse voice present

Respiratory system

* Costochondral involvement may cause a restrictive deficit and decreased tidal volume
* Interstitial fibrosis can cause a V/Q mismatch

Cardiovascular system

* Coronary arteritis
* Conduction abnormalities
* Immobility may obscure underlying symptoms of cardiovascular system disease

Anaemia

* Chronic anaemia often present
* Treatment with non-steroidal anti-inflammatory drugs can cause gastrointestinal blood loss

Renal failure

* May be caused by amyloidosis or chronic drug treatment

Steroid therapy

* Steroid cover needed
* Postoperative infection can occur

Investigations

* Full blood count, urea & electrolytes, chest X-ray, cervical spine X-ray, ECG, pulmonary function in some cases

Conduct of anaesthesia

* Careful positioning
* Difficult intubation set ready
* Awake fibreoptic if necessary
* Regional blockade preferable

they love asking about this question on the oral boards.... they love it

 

[IceDoc]

Respiratory system

* Costochondral involvement may cause a restrictive deficit and decreased tidal volume

Had a patient with RA that after sternotomy, the ribs were so fused that they wouldn't spread open.

Light wands can be your friends.

 

[bubalus]

Roizen's Essence of Anesthesia Practice is a great resource for the one page reviews of a variety of medical problems--RA, VWF, MS, etc. AT least some of the editions came with a palm version on CD. If you're a Pocket PC user, you can use styletap as an emulator. I like having the electronic version while I'm at work and the text at home.