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vol. 57

Airway management for general anesthesia in patients with rheumatic diseases – new possibilities

Tomasz Gaszyński

Department of Anaesthesiology and Intensive Therapy, Medical University of Lodz, Poland
Reumatologia 2019; 57, 2: 69-71
Online publish date: 2019/04/29
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JabRef, Mendeley
Papers, Reference Manager, RefWorks, Zotero
Airway management for general anesthesia in patients with rheumatic diseases can be very challenging because of changes related to the disease, especially in temporomandibular joints and the cervical spine.
In this case airway and neck assessment is crucial; atlanto-axial subluxation can be detected and there is a potential risk of spinal cord damage when performing airway management. For most cases awake fibreoptic intubation may be required for airway management, which is considered as the standard approach [1].
Changes in the cervical spine include sclerosis, discopathy, and instability of vertebral joints with the possibility of subluxations. The conditions may be complicated by previous surgery for stabilization of the cervical spine and discopathy treatment. Changes in joints can be related to several rheumatoid diseases. For airway management inflammation of temporomandibular joints and vertebral joints in the cervical spine is important.
For airway management, the implication will be especially the reduction of mouth opening and a commonly occurring cervical stiffness that make both the intubation procedures and the positioning of head and neck difficult. For evaluation one may use the Mallampati score, mouth opening and mandible protrusion as preoperative predictors of temporomandibular dysfunction.
Cricoarytenoid dysfunction is another factor influencing difficulties related to airway management. The larynx may be affected in approximately 80% of patients. The symptoms may be presented as foreign body sensation in the oropharynx, dysphagia, dyspnea, hoarseness, stridor, and also by airway obstruction. As possible diagnosis during visualization of the larynx may reveal cricoarytenoid and vocal cord dysfunction during inspiration.
For patients with this disease fiberoptic nasoendoscopy is recommended and the use of a tracheal tube with a small diameter that can provide appropriate ventilation. It is important to avoid trauma of the laryngeal structures. For safe extubation the removal of the tracheal tube should take place in an appropriate environment prepared for emergencies. In some cases even preventive preoperative tracheostomy should be considered [2].
The use of fiber optic bronchoscopy is recommended in such cases, because it allows adequate access to the airways with minimal cervical mobilization. Awake intubation should be considered but it requires a suitably trained anesthesiologist, with minimal...

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