Diseases and Surgical Procedures

Rheumatoid Arthritis Disease – Quick overview

Airway

In rheumatoid arthritis there is involvement of TMJ

C-S 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 with rheumatoid arthritis can cause a V/Q mismatch

Cardiovascular System

Coronary arteritis

Conduction abnormalities

Immobility may obscure underlying symptoms of CVS disease

Common diseases

Anemia

Chronic anemia often present

Treatment with NSAIDs can cause GI blood loss

Renal Failure

May be caused by amyloidosis or chronic drug treatment

Treatment of Rheumatoid Arthritis

Steroid therapy

Steroid cover needed

Post-operative infection can occur

Tests

Full blood count (CBC), Urea & Electrolytes (MBP/Chem7), CXR, C-spine, ECG, pulmonary function in some cases

Conduct of Anesthesia

Careful positioning

Difficult intubation set ready

Awake fiberoptic if necessary

Regional blockade preferable