Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942011000300013
Brazilian Journal of Anesthesiology
Review Article

Anestesia e artrite reumatoide

Anesthesia and rheumatoid arthritis

Eneida Maria Vieira; Stuart Goodman; Pedro Paulo Tanaka

http://dx.doi.org/10.1590/S0034-70942011000300013 Braz J Anesthesiol, vol.61, n3, p.371-375, 2011
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Resumo

JUSTIFICATIVA E OBJETIVOS: A artrite reumatoide (AR) é uma doença inflamatória crônica e de etiologia desconhecida. Os pacientes com AR são reconhecidos como pessoas com redução na expectativa de vida, em comparação com a população em geral. As doenças reumáticas são numerosas e ocorrem com alta variabilidade; algumas são desenvolvidas rapidamente; outras, cronicamente, provocando incapacidades durante toda a vida. Os riscos anestésicos, em desordens osteoarticulares, envolvem, além das deformidades mecânicas causadas pela doença, os sistemas cardiovascular, respiratório, renal e digestivo. CONTEÚDO: A proposta da presente revisão foi levantar a importância das fases da doença em processo, que podem influenciar no controle da anestesia antes, durante e após a cirurgia, destacando a experiência dos autores em uma avaliação retrospectiva dos casos de pacientes portadores de artrite reumatoide juvenil (ARJ) submetidos a próteses ortopédicas, com ênfase para as técnicas de intubação. CONCLUSÕES: Pacientes com artrite reumatoide podem apresentar um bom número de problemas complexos para o anestesiologista. Isso requer uma cuidadosa avaliação pré-operatória; a anestesia requer experiência com a técnica e o cuidado pós-operatório deve ser criteriosamente escolhido para atender à necessidade específica do paciente. O procedimento demanda efetiva comunicação entre cirurgião, reumatologista e anestesiologista, para que cada membro do grupo multidisciplinar contribua com sua experiência, visando a um melhor benefício ao paciente.

Palavras-chave

ANESTESIA, CIRURGIA, Cuidados pré-operatórios, COMPLICAÇÕES, Intubação traqueal, DOENÇAS, Reumatológicas

Abstract

BACKGROUND AND OBJECTIVES: Rheumatoid arthritis (RA) is a chronic inflammatory disease of unknown etiology. It is known that RA patients have a reduced life expectancy when compared with the general population. Rheumatic diseases are numerous and occur with high variability; some of them develop very rapidly while others occur chronically provoking disability throughout life. Anesthetic risks in osteoarticular disorders involve not only the mechanical deformations caused by the disease, but also the cardiovascular, respiratory, renal, and digestive systems. CONTENTS: The purpose of this review was to stress the importance of stages in disease process that may affect anesthesia control before, during, and after surgery, highlighting the authors' experience in a retrospective review of patients with juvenile rheumatoid arthritis (JRA) undergoing placement of orthopedic prosthesis with emphasis on intubation techniques. CONCLUSIONS: Rheumatoid arthritis patients can present a number of complex problems for the anesthesiologist. This requires careful preoperative evaluation; anesthesia requires experience with the technique; and postoperative care should be judiciously chosen to meet the specific needs of the patient. The procedure requires effective communication among surgeon, rheumatologist and anesthesiologist so each member of the multidisciplinary team can contribute with his/her expertise in order to better benefit the patient.

Keywords

Arthritis, Rheumatoid, Arthritis, Juvenile Rheumatoid, Anesthesia, Perioperative Care, Intubation, Intratracheal

References

Lisowska B, Rutkowska-Sak L, Maldyk P. Anaesthesiological problems in patients with rheumatoid arthritis undergoing orthopaedic surgeries. Clin Rheumatol. 2008;27:553-556.

Skues MA, Welchew EA. Anaesthesia and rheumatoid arthritis. Anaesthesia. 1993;48:989-997.

Charlin B, Brazeau-Lamontagne L, Levesque RY. Cricoarytenoiditis in rheumatoid arthritis comparison of fibrolaryngoscopic and high resolution computerized tomographic findings. J Otolaryngol. 1985;14:381-386.

Tokunaga D, Hase H, Mikami Y. Atlantoaxial subluxation in different intraoperative head positions in patients with rheumatoid arthritis. Anesthesiology. 2006;104:675-679.

Gurcay E, Eksioglu E, Yuser S. Articular damage in adults with juvenile idiopathic arthritis. Rheumatol Int. 2009;29:635-640.

Ansell BM. Classification and Nomenclature. Paediatric Rheumatology Update. 1990:3-5.

Winkler M, Marker E, Hertz M. The peri-operative management of major orthopaedic procedures. Anaesthesia. 1998;53(^ssuppl):37-41.

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

Leicht MJ, Harrington TM, Davis DE. Cricoarytenoid arthritis: a cause of laryngeal obstruction. Ann Emerg Med. 1987;16:885-888.

Galvin EM, O'Donnell D, Leonard IE. Rheumatoid arthritis: a significant but often underestimated risk factor for perioperative cardiac morbidity. Anesthesiology. 2005;103:910-911.

Goodson N. Coronary artery disease and rheumatoid arthritis. Curr Opin Rheumatol. 2002;14:115-120.

Begin R, Radoux V, Cantin A. Stiffness of the rib cage in a subset of rheumatoid patients. Lung. 1988;166:141-148.

Collins RL, Turner RA, Johnson AM. Obstructive pulmonary disease in rheumatoid arthritis. Arthritis Rheum. 1976;19:623-628.

Geddes DM, Webley M, Emerson PA. Airways obstruction in rheumatoid arthritis. Ann Rheum Dis. 1979;38:222-225.

Boers M, Dijkmans BA, Breedveld FC. Subclinical renal dysfunction in rheumatoid arthritis. Arthritis Rheum. 1990;33:95-101.

Dieppe PA, Doyle DV, Burry HC. Renal disease in rheumatoid arthritis. Br Med J. 1976;1:611-612.

Plumpton FS, Besser GM, Cole PV. Corticosteroid treatment and surgery: The management of steroid cover. Anaesthesia. 1969;24:12-18.

Kehlet H. A rational approach to dosage and preparation of parenteral glucocorticoid substitution therapy during surgical procedures: A short review. Acta Anaesthesiol Scand. 1975;19:260-264.

Keenan MA, Stiles CM, Kaufman RL. Acquired laryngeal deviation associated with cervical spine disease in erosive polyarticular arthritis: Use of the fiberoptic bronchoscope in rheumatoid disease. Anesthesiology. 1983;58:441-449.

Vaughan RS. Training in fibreoptic laryngoscopy. Br J Anaesth. 1991;66:538-540.

Wood M. Plasma drug binding: implications for anesthesiologists. Anesth Analg. 1986;65:786-804.

Pihlajamaki KK, Lindberg RLP. Bupivacaine with and without adrenaline in interscalene brachial plexus blockade: Studies in patients with rheumatoid arthritis. Br J Anaesth. 1987;59:1420-1424.

Davies SF, Iber C. Obstructive sleep apnea associated with adultacquired micrognathia from rheumatoid arthritis. Am Rev Resp Dis. 1983;127:245-247.

Lavie P, Nahir M, Lorber M. Nonsteroidal antiinflammatory drug therapy in rheumatoid arthritis patients: Lack of association between clinical improvement and effects on sleep. Arthritis Rheum. 1991;34:655-659.

Gordon DA, Stein JL, Broder I. The extra-articular features of rheumatoid arthritis: A systematic analysis of 127 cases. Am J Med. 1973;54:445-452.

Gardner DL, Holmes F. Anaesthetic and postoperative hazards in rheumatoid arthritis. Br J Anaesth. 1961;33:258-264.

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