Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942007000200011
Brazilian Journal of Anesthesiology
Review Article

Espondilite anquilosante e anestesia

Ankylosing spondylitis and anesthesia

Carlos Rogério Degrandi Oliveira

http://dx.doi.org/10.1590/S0034-70942007000200011 Braz J Anesthesiol, vol.57, n2, p.214-222, 2007
PDF Português
PDF English
Downloads: 4
Views: 1465

Resumo

JUSTIFICATIVA E OBJETIVOS: A espondilite anquilosante (EA) é uma doença inflamatória crônica das articulações, incluída no grupo das espondiloartropatias soronegativas. A característica principal dessa doença é a fusão óssea da coluna vertebral que leva à perda permanente da flexibilidade do dorso e do pescoço. Outras grandes articulações e tecidos conectivos poderão estar afetados pelo processo inflamatório. A EA acomete principalmente homens entre 20 e 40 anos; é rara após os 50 anos. As mulheres correspondem somente à minoria de pacientes. Há pouca informação sobre a EA na literatura anestésica. O objetivo deste artigo foi revisar aspectos da EA de interesse para o anestesiologista, permitindo um adequado manuseio perioperatório. CONTEÚDO: Estão definidas as características da espondilite anquilosante quanto à clínica e a conduta anestésica. CONCLUSÕES: Os pacientes com doenças crônicas da coluna vertebral apresentam desafios específicos para o anestesiologista. O manuseio da via aérea e o acesso ao neuroeixo poderão ser difíceis. Preferência tem sido dada à anestesia geral, mesmo com via aérea difícil reconhecida, evitando-se a anestesia no neuroeixo. O grau de envolvimento da coluna cervical determinará o quanto poderá ser difícil a intubação traqueal. Cuidado especial deve ser tomado para evitar a manipulação excessiva da coluna cervical, que poderia levar ao trauma da medula espinhal.

Palavras-chave

ANESTESIA, Geral, DOENÇAS

Abstract

BACKGROUND AND OBJECTIVES: Ankylosing spondylitis (AS) is a chronic inflammatory disease of the joints, included in the group of seronegative spondyloarthropathies. Its main characteristic is the fusion of the bones in the spine, which causes loss of flexibility of the back and neck. Other large articulations and connective tissues can be affected by the inflammatory process. It affects mainly men between the ages of 20 and 40; it is rare after the age of 50. Women represent a minority of patients. There is little information about AS in the anesthetic literature. The objective of this article was to review the characteristics of AS pertaining anesthesiology for an adequate perioperative handling. CONTENTS: The clinical characteristics of ankylosing spondylitis pertaining to the anesthetic conduct are reviewed. CONCLUSIONS: Patients with chronic diseases of the spine represent specific challenges to the anesthesiologist. Handling of the airways and the access to the neuroaxis can be difficult. Most anesthesiologists prefer to use general anesthesia, avoiding the neuroaxis, in those patients, despite the presence of difficult airways. The degree of spine involvement will determine how difficult the tracheal intubation might be. Special care should be taken to avoid excessive manipulation of the neck, which could cause trauma to the spinal cord.

Keywords

ANESTHESIA, general, DISEASES

References

Van der Linden S, Van der Heijde D. Ankylosing spondylitis. Clinical features. Rheum Dis Clin North Am. 1998;24:663-676.

Sampaio-Barros PD, Bertolo MB, Kraemer MH. Primary ankylosing spondylitis: patterns of disease in a Brazilian population of 147 patients. J Rheumatol. 2001;28:560-565.

Popitz MD. Anesthetic implications of chronic disease of the cervical spine. Anesth Analg. 1997;84:672-683.

Van der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum. 1984;27:361-368.

Podolsky SM, Hoffman JR, Pietrafesa CA. Neurological complications following immobilization of cervical spine fracture in a patient with ankylosing spondylitis. Ann Emerg Med. 1983;12:578-580.

Tetzlaff JE, Yoon HJ, Bell G. Massive bleeding during spine surgery in a patient with ankylosing spondylitis. Can J Anaesth. 1998;45:903-906.

Dave N, Sharma RK. Temporomandibular joint ankylosis in a case of ankylosing spondylitis anaesthetic management. Indian J Anaesth. 2004;48:54-56.

Reginster JY, Damas P, Franchimont P. Anaesthetic risks in osteoarticular disorders. Clin Rheumatol. 1985;4:30-38.

Ruf M, Rehm S, Poeckler-Schoeniger C. Iatrogenic fractures in ankylosing spondylitis a report of two cases. Eur Spine J. 2006;15:100-104.

Ovassapian A, Land P, Schafer MF. Anesthetic management for surgical corrections of severe flexion deformity of the cervical spine. Anesthesiology. 1983;58:370-372.

Broomhead CJ, Davies W, Higgins D. Awake oral fibreoptic intubation for caesarean section. Int J Obstet Anesth. 1995;4:172-174.

Sinclair JR, Mason RA. Ankylosing spondylitis: The case for awake intubation. Anaesthesia. 1984;39:3-11.

MeIo MCBF, Charello RR. Intubação traqueal em paciente acometido de espondilite anquilosante. São Paulo Med J. 2005;123:42.

Kamarkar US, Chaudhari LS, Hosalkar H. Difficult intubation in a case of ankylosing spondylitis: a case report. J Postgrad Med. 1998;44:43-46.

Ahmad N, Channa AB, Mansoor A. Management of difficult intubation in a patient with ankylosing spondylitis a case report. Middle East J Anesthesiol. 2005;18:379-384.

Oliveira CRD, Sawada TC, Nogueira CS. Intubação orotraqueal acordada com estilete luminoso em gestante com espondilite anquilosante. Relato de caso, em: Congresso Brasileiro de Anestesiologia, 52., 2005, Goiânia. Anais ... 2005.

Moreira ES, Machado MR, Guanabarino MSF. Dificuldade no manuseio anestésico de paciente com espondilite anquilosante. Relato de caso. Rev Bras Anestesiol. 2003;53(^s31):218B.

Roberts KW, Solgonick RM. A modification of retrograde wire-guided, fiberoptic-assisted endotracheal intubation in a patient with ankylosing spondilytis. Anesth Analg. 1996;82:1290-1291.

Lu PP, Brimacombe J, Ho AC. The intubating laryngeal mask airway in severe ankylosing spondylitis. Can J Anaesth. 2001;48:1015-1019.

Hsin ST, Chen CH, Juan CH. A modified method for intubation of a patient with ankylosing spondylitis using intubating laryngeal mask airway (LMA-Fastrach) a case report. Acta Anaesthesiol Sin. 2001;39:179-182.

Schelew BL, Vaghadia H. Ankylosing spondylitis and neuraxial anaesthesia a 10 year review. Can J Anaesth. 1996;43:65-68.

Kumar CM, Mehta M. Ankylosing spondylitis: lateral approach to spinal anaesthesia for lower limb surgery. Can J Anaesth. 1995;42:73-76.

DeBoard JW, Ghia JN, Guilford WB. Caudal anesthesia in a patient with ankylosing spondylitis for hip surgery. Anesthesiology. 1981;54:164-166.

Hyderally HA. Epidural hematoma unrelated to combined spinal-epidural anesthesia in a patient with ankylosing spondylitis receiving aspirin after total hip replacement. Anesth Analg. 2005;100:882-883.

Gustafsson H, Rutberg H, Bengtsson M. Spinal haematoma following epidural analgesia. Report of a patient with ankylosing spondylitis and a bleeding diathesis. Anaesthesia. 1988;43:220-222.

Wulf H. Epidural anaesthesia and spinal haematoma. Can J Anaesth. 1996;43:1260-1271.

Robins K, Saravanan S, Watkins EJ. Ankylosing spondylitis and epidural haematoma. Anaesthesia. 2005;60:624-625.

Weber S. Caudal anesthesia complicated by intraosseous injection in a patient with ankylosing spondylitis. Anesthesiology. 1985;63:716-717.

Bourlier RA, Birnbach DJ. Anesthetic management of the parturient with ankylosing spondylitis. Int J Obstet Anesth. 1995;4:244-247.

Hiruta A, Fukuda H, Hiruta M. Anesthetic management of caesarean section in a parturient with ankylosing spondylitis complicated with severe cervical myelitis. Masui. 2002;51:759-761.

Chowbey PK, Panse R, Khullar R. Laparoscopic cholecystectomy in a patient with ankylosing spondylitis with severe spinal deformity. Surg Laparosc Endosc Percutan Tech. 2005;15:234-237.

Wittmann FW, Ring PA. Anaesthesia for hip replacement in ankylosing spondylitis. J R Soc Med. 1986;79:457-459.

Parvizi J, Duffy GP, Trousdale RT. Total knee arthroplasty in patients with ankylosing spondylitis. J Bone Joint Surg Am. 2001;83:1312-1316.

Lu H, Yuan Y, Kou B. Reconstruction of hip, knee, and ankle bony fused in non-functional position of ankylosing spondylitis patients. Zhonghua Wai Ke Za Zhi. 2000;38:749-751.

Baeza C, Fornet I, Garces G. Anestesia para la intervención de osteoclasia vertebral en un paciente con espondilitis anquilopoyética grave de predominio cervical. Rev Esp Anestesiol Reanim. 1993;40:365-367.

Hamano N, Murao K, Sakamoto S. Anesthesia for a severe ankylosing spondylitis patient whose posture had been restricted to only sitting for over 20 years. Masui. 2002;51:1026-1028.

McMaster MJ. Osteotomy of the cervical spine in ankylosing spondylitis. J Bone Joint Surg Br. 1997;79:197-203.

Lin BC, Chen IH. Anesthesia for ankylosing spondylitis patients undergoing transpedicle vertebrectomy. Acta Anaesthesiol Sin. 1999;37:73-78.

Shimizu K, Matsushita M, Fujibayashi S. Correction of kyphotic deformity of the cervical spine in ankylosing spondylitis using general anesthesia and internal fixation. J Spinal Disord. 1996;9:540-543.

Calin A, Elswood J. A prospective nationwide cross-sectional study of NSAID usage in 1331 patients with ankylosing spondylitis. J Rheumatol. 1990;17:801-803.

Dougados M, Behier JM, Jolchine I. Efficacy of celecoxib, a cyclooxygenase 2-specific inhibitor, in the treatment of ankylosing spondylitis: a six-week controlled study with comparison against placebo and against a conventional nonsteroidal antiinflamatory drug. Arthritis Rheum. 2001;44:180-185.

Peters ND, Ejstrup L. Intravenous methylprednisolone pulse therapy in ankylosing spondylitis. Scand J Rheumatol. 1992;21:134-138.

Braun J, Bollow M, Seyrekbasan F. Computed tomography guided corticosteroid injection of the sacroiliac joint in patients with spondyloarthropathy with sacroiliitis: clinical outcome and follow-up by dynamic magnetic resonance imaging. J Rheumatol. 1996;23:659-664.

Dougados M, Van der Linden S, Leirisalo-Repo M. Sulfasalazine in the treatment of spondylarthropathy: a randomized multicenter, double-blind, placebo-controlled study. Arthritis Rheum. 1995;38:618-627.

Sampaio-Barros PD, Costallat LT, Bertolo MB. Methotrexate in the treatment of ankylosing spondylitis. Scand J Rheumatol. 2000;29:160-162.

Huang F, Gu J, Zhao W. One-year open-label trial of thalidomide in ankylosing spondylitis. Arthritis Rheum. 2002;47:249-254.

Maksymowych WP, Jhangri GS, Fitzgerald AA. A six-month randomized, controlled, double-blind, dose-response comparison of intravenous pamidronate (60 mg versus 10 mg) in the treatment of nonsteroidal antiinflammatory drug-refractory ankylosing spondylitis. Arthritis Rheum. 2002;46:766-773.

Van Den Bosch F, Kruithof, Baeten D. Randomized double-blind comparison of chimeric monoclonal antibody to tumor necrosis factor alpha (infliximab) versus placebo in active spondylarthropathy. Arthritis Rheum. 2002;46:755-765.

Davis JC Jr, Van der Heijde D, Braun J. Recombinant human tumor necrosis factor receptor (etanercept) for treating ankylosing spondylitis: a randomized controlled trial. Arthritis Rheum. 2003;48:3230-3236.

Maksymowych W, Inman RD, Gladman D. Canadian Rheumatology Association Consensus on the use of anti-tumor necrosis factor-alpha directed therapies in the treatment of spondyloarthritis. J Rheumatol. 2003;30:1356-1363.

Baraliakos X, Brandt J, Listing J. Clinical response to discontinuation of anti-TNF therapy in patients with ankylosing spondylitis after 3 years of continuous treatment with infliximab. Arthritis Res Ther. 2005;7:439-444.

5dd843530e8825b06613f28c rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections