Airway
- Involvement of temporomandibular joints
- Cervical spine fixed/subluxed and therefore can be unstable
- Cricoarytenoid involvement should be suspected if hoarse voice present
Respiratory system
- Costochondral involvement may cause a restrictive deficit and decreased tidal volume
- Interstitial fibrosis can cause a V/Q mismatch
Cardiovascular system
- Coronary arteritis
- Conduction abnormalities
- Immobility may obscure underlying symptoms of cardiovascular system disease
Anaemia
- Chronic anaemia often present
- Treatment with non-steroidal anti-inflammatory drugs can cause gastrointestinal blood loss
Renal failure
- May be caused by amyloidosis or chronic drug treatment
Steroid therapy
- Steroid cover needed
- Postoperative infection can occur
Investigations
- Full blood count, urea & electrolytes, chest X-ray, cervical spine X-ray, ECG, pulmonary function in some cases
Conduct of anaesthesia
- Careful positioning
- Difficult intubation set ready
- Awake fibreoptic if necessary
- Regional blockade preferable
ArticleDate:20041109
SiteSection: Article
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