Avoid Steroids, Prednisone
Manage Cardiac and Vascular Issues
|Manage Gastrointestinal Issues
Care should be taken to select the best anesthetic or analgesia for systemic sclerosis (scleroderma) patients, with consideration of their entire medical history plus general risk factors for scleroderma.
Systemic scleroderma can affect every part of the body, including the skin, blood vessels, internal organs, and central nervous system. (Also see What is Scleroderma?, Medical Overview, and Medications for Scleroderma, Arthritis, Autoimmune and Rheumatic Diseases)
Corticosteroids greatly increase the risk of death in scleroderma patients. In particular, corticosteroids strongly increase the risk of developing scleroderma renal crisis. They also cause a 70% increased risk of pneumonia in scleroderma patients. (Also see Glucocorticoids, Steroids (Prednisone) Warnings for Scleroderma)
Avoiding vasoconstrictive agents, such as epinephrine, is vital to prevent attacks of Raynaud's. Scleroderma patients are also at risk for cardiac complications, such as dysrhythmia and blood clots. Keeping the patient very warm during all phases of nursing and surgical care can also help prevent attacks of Raynaud's, which is important as a single unmanaged attack can lead to digital ulcers, gangrene, and amputation in scleroderma patients. (Also see:Cardiac Involvement, and Raynaud's)
Arthritis Patients Face Increased Risk of Blood Clots. People with lupus, rheumatoid arthritis and other autoimmune diseases are more likely to get dangerous blood clots when hospitalized. Researchers say it's possible that inflammation is causing this increased risk. Jennifer Davis. Arthritis Today. 01/19/2011. (Also see Anesthesia and Scleroderma)
Neuroaxial anesthesia in a patient with progressive systemic sclerosis. Every aspect of anesthetic care may be altered or hindered by the pathogenesis of disease. Although the choice of regional or general anesthesia is unclear, to choose combined spinal epidural anesthesia may be useful. PubMed, BMC Anesthesiol.
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