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Ra
Started by Varmit22
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Stoelting's Anesthesia and Coexisting Disease will probably get >95% of what you need to know.
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
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
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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.
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.
