RECENT UPDATES IN ANESTHETIC MANAGEMENT OF PATIENT WITH RHEUMATOID ARTHRITIS

Abstract

Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease of unknown etiology affecting both articular tissues and extraarticular organs. The disease is often progressive and results in pain, stiffness, and swelling of joints culminating in significant morbidity and increased mortality. There has been a great deal of progress in our understanding and management of rheumatoid arthritis in recent years. The peri-operative management of rheumatoid arthritis patients can be challenging and anaesthetists need to be familiar with recent developments and potential risks of this multi system disease. Rheumatoid arthritis patients can present a large number of complex problems for the anesthesiologist. This requires careful preoperative evaluation; anesthesia requires experience with the technique; and postoperative care should be carefully chosen to meet specific patient needs. The procedure demands effective communication between surgeon, rheumatologist, and anesthesiologist so each member of the multidisciplinary team can contribute with his/her expertise, in order to better benefit the patient. The anesthesiologist must be aware of airway pathologies and be fully prepared with various options and equipment in case a problem arises with an airway. The potential for cervical spine instability exists in patients with rheumatologic disorders, therefore intubating with care and avoiding spinal movement both seem to be more important than any particular mode of intubation in preserving neurologic function. When difficulty in establishing an airway is anticipated, it is prudent to attempt airway control in the operating room with surgical assistance standing by in case cervical tracheotomy is required. Post operative rehabilitation and pain management shouldn't be overlooked , especially since RA patients usually present for orthopedic interventions and are usually in need for clearly planned protocols to guide them through the post operative period.