Canadian Journal of Anesthesia, Vol 16, 407-415, Copyright © 1969 by Canadian Anesthesiologists' Society

Anaesthetic Management of the Patient with Rheumatoid Arthritis

¹ Divisions of Anaesthesia and Orthopaedic Surgery, Vancouver General Hospital and University of British Columbia

Rheumatoid arthritis is a relatively common disease for which surgical treatment is being employed with increasing frequency. The improved results are the product of the co-ordinated efforts of many medical and paramedical disciplines. The skill of anaesthetic management is an important contributing factor.

From our experiences during the past five years, special problems can be anticipated. These are: airway impairment (secondary to hypoplastic mandible, temporomandibular joint ankylosis, cervical spine restriction, atlanto-axial subluxation, low cervical subluxation, cricoarytenoid arthritis and laryngeal tissue damage); respiratory inadequacy (rheumatoid lung nodules, chronic lung diffusing interstitial fibrosis, costovertebral joint fixation, and thoracic vertebral fixation deformity); cardiovascular impairment (pericardium, myocardium, coronary artery, regurgitant aortic valve involvement, and disseminated necrotizing arteritis); haemopoietic defects (anaemia, leucopenia, and bleeding tendencies); renal and hepatic dysfunction; drug therapy hazards; problems in posturings; and hazards associated with multiple anaesthetics and surgical procedures.

Advanced rheumatoid arthritis is a crippling, incapacitating disease. Corrective surgical procedures offer new hope and great potentiality for its victims. Care in the anaesthetic management of these patients can significantly contribute to the successful outcome of these procedures.