Artritis reumatoide y anestesia

Artritis reumatoidea y anestesia Rheumatoid arthritis and anaesthesia R. Samanta, K. Shoukrey and R. Griffiths Specialist Registrar, Consultant, Department of Anaesthesia, Peterborough City Hospital, Peterborough, UK, Specialist Registrar, Department of Anaesthesia, Addenbrooke's Hospital, Cambridge, UK Anaesthesia, 2011, 66, pages 1146-1159 Summary 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. http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2044.2011.06890.x/pdf   Artritis reumatoidea de la columna cervical. Consideraciones clínicas Rheumatoid arthritis of the cervical spine - clinical considerations. Wasserman BR, Moskovich R, Razi AE. Bull NYU Hosp Jt Dis. 2011;69(2):136-48. Abstract Rheumatoid arthritis (RA) is a chronic, systemic infammatory disorder affecting multiple organ systems, joints, ligaments, and bones and commonly involves the cervical spine. Chronic synovitis may result in bony erosion and ligamentous laxity that result in instability and sublux-ation. Anterior atlantoaxial subluxation (AAS) is the most frequently occurring deformity, due to laxity of the primary and secondary ligamentous restraints. Additional manifestations of RA include cranial settling, subaxial subluxation, or a combination of these. Although clinical fndings can be confounded by the severity of multifocal joint and systemic involvement, a careful history is critical to identify symptoms of cervical disease; serial physical examination is the best noninvasive diagnostic tool. Thorough physical and neurologic examinations should be performed in all patients and serial functional assessments charted. Radiographs of the cervical spine with lateral fexion-extension dynamic views should be obtained periodically and used to "clear" the cervical spine before elective surgery requiring general anesthesia. Advanced imaging, such as magnetic resonance imaging (MRI) or myelography and computed tomography (CT), may be necessary to evaluate the neuraxis. Early initiation of pharmacotherapy may slow progression of rheumatoid cervical disease. Operative intervention before the onset of advanced myelopathy results in improved outcomes compared to the surgical stabilization of patients whose conditions are more advanced. A multidisciplinary approach involving rheumatology, surgery, and rehabilitation is benefcial to optimize outcomes. http://www.nyuhjdbulletin.org/Mod/Bulletin/V69N2/Docs/V69N2_7.pdf   Anestesia para reemplazo de articulaciones. Problemas con enfermedades coexistentes Anesthesia for joint replacement surgery: Issues with coexisting diseases. Kakar PN, Roy PM, Pant V, Das J. Department of Anesthesiology Pain management and Perioperative care, Fortis Hospital, Shalimar Bagh, New Delhi, India. J Anaesthesiol Clin Pharmacol. 2011 Jul;27(3):315-22. Abstract The first joint replacement surgery was performed in 1919. Since then, joint replacement surgery has undergone tremendous development in terms of surgical technique and anesthetic management. In this era of nuclear family and independent survival, physical mobility is of paramount importance. In recent years, with an increase in life expectancy, advances in geriatric medicine and better insurance coverage, the scenario of joint replacement surgery has changed significantly. Increasing number of young patients are undergoing joint replacement for pathologies like rheumatoid arthritis and ankylosing spondylitis. The diverse pathologies and wide range of patient population brings unique challenges for the anesthesiologist. This article deals with anesthetic issues in joint replacement surgery in patients with comorbidities http://www.joacp.org/temp/JAnaesthClinPharmacol273315-8582991_235029.pdf

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