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Ebook Preoperative assessment and management (2nd edition): Part 2

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Nội dung chi tiết: Ebook Preoperative assessment and management (2nd edition): Part 2

Ebook Preoperative assessment and management (2nd edition): Part 2

11Musculoskeletal and Autoimmune DiseasesParwane s. ParsaThis chapter reviews the preoperative evaluation of patients with musculoskeletal and autoimm

Ebook Preoperative assessment and management (2nd edition): Part 2mune diseases. The autoimmune diseases discussed in this section include rheumatoid arthritis, ankylosing spondylitis, systemic lupus erythematosus, a

nd scleroderma, other musculoskeletal diseases included in this chapter are osteoarthritis and kyphoscoliosis. Marfan syndrome and other inherited con Ebook Preoperative assessment and management (2nd edition): Part 2

nective tissue diseases are reviewed. These entities are distinguished by variable disease severity and frequent multisystem effects requiring careful

Ebook Preoperative assessment and management (2nd edition): Part 2

preoperative investigation. This chapter discusses strategies to identify and treat patients with consequent pulmonary and cardiac involvement and al

11Musculoskeletal and Autoimmune DiseasesParwane s. ParsaThis chapter reviews the preoperative evaluation of patients with musculoskeletal and autoimm

Ebook Preoperative assessment and management (2nd edition): Part 2se, affects up to 1% of the population, typically ranging in age from 40 to 70 years. Incidence of the disease is greater in females than in males (ra

tio of 2.5:1) (1). In addition to the characteristic joint inflammation, multiple organ systems are impacted by the disease, requiring careful evaluat Ebook Preoperative assessment and management (2nd edition): Part 2

ion.GeneralPatients with RA may report fatigue, malaise, weight loss, and fever.ArthropathyThe disease involves multijoint inflammation and morning st

Ebook Preoperative assessment and management (2nd edition): Part 2

iffness of both small and large joints of the extremities. The temporomandibular joint, cervical spine, and cricoarytenoid cartilages are frequently a

11Musculoskeletal and Autoimmune DiseasesParwane s. ParsaThis chapter reviews the preoperative evaluation of patients with musculoskeletal and autoimm

Ebook Preoperative assessment and management (2nd edition): Part 2l neuropathy associated with vasculitis and nerve entrapment occurs with RA.260 Handbook of Preoperative Assessment and ManagementPulmonaryDecreased t

horacic mobility can produce a restrictive defect; other associated pulmonary disorders include pleural effusions and interstitial fibrosis also resul Ebook Preoperative assessment and management (2nd edition): Part 2

ting in predominantly restrictive lung disease.RenalPatients with RA can have renal vasculitis.HematologicAnemia, leucocytosis, thrombocytosis, and sp

Ebook Preoperative assessment and management (2nd edition): Part 2

lenomegaly with thrombocytopenia can be present.DermatologicRheumatoid nodules, dry eyes, vasculitis, and salivary inflammation are typical.HistoryThe

11Musculoskeletal and Autoimmune DiseasesParwane s. ParsaThis chapter reviews the preoperative evaluation of patients with musculoskeletal and autoimm

Ebook Preoperative assessment and management (2nd edition): Part 2symptoms, and the best level of activity the patient can achieve. A history of neck stiffness, crepitation with neck movement, hoarseness, stridor, an

d any neurologic deficits is elicited. The evaluator asks about dyspnea with exertion, orthopnea, anemia, and chest pain or pressure. Extra-articular Ebook Preoperative assessment and management (2nd edition): Part 2

effects of RA and any recent hospital admissions are discussed. Current medications are listed along with any history of adverse drug effects.Physical

Ebook Preoperative assessment and management (2nd edition): Part 2

ExaminationGeneralObserve the patient for signs of anemia (such as pallor or tachycardia) or malnutrition. Examine the extremities for degree of join

11Musculoskeletal and Autoimmune DiseasesParwane s. ParsaThis chapter reviews the preoperative evaluation of patients with musculoskeletal and autoimm

Ebook Preoperative assessment and management (2nd edition): Part 2ortant in patients with RA. Limited neck flexion or extension from cervical spine involvement may make positioning and laryngoscopy difficult. Similar

ly, a limited oral aperture may hamper intubation. Atlanto-occipital subluxation caused by ligament laxity can be found in any patient with RA; the in Ebook Preoperative assessment and management (2nd edition): Part 2

cidence is up to 46%. The direction of the subluxation is anterior in the majority of cases (3). Patients, therefore, are at risk for spinal cord comp

Ebook Preoperative assessment and management (2nd edition): Part 2

ression and nermanent neurologic iniurv with excessive movement dur-11. Musculoskeletal and Autoimmune Diseases 261CardiopulmonaryObserve the patient

11Musculoskeletal and Autoimmune DiseasesParwane s. ParsaThis chapter reviews the preoperative evaluation of patients with musculoskeletal and autoimm

Ebook Preoperative assessment and management (2nd edition): Part 2, or rales consistent with pulmonary fibrosis. Document murmurs or rubs from valvular insufficiency or pericarditis.Diagnostic TestingLaboratory Tests

Because anemia is a common feature of RA, a complete blood count (CBC) with platelets is ordered lor patients who will have surgery with any expected Ebook Preoperative assessment and management (2nd edition): Part 2

blood loss. For individuals with renal or cardiac disease, blood urea nitrogen (BUN), creatinine, and electrolytes are measured.RadiologyBecause of th

Ebook Preoperative assessment and management (2nd edition): Part 2

e high incidence of atlantoaxial subluxation in patients with RA, preoperative cervical spine (C-spine) radiographs are performed in patients who are

11Musculoskeletal and Autoimmune DiseasesParwane s. ParsaThis chapter reviews the preoperative evaluation of patients with musculoskeletal and autoimm

Ebook Preoperative assessment and management (2nd edition): Part 2) view of the C-spine, an AP odontoid view, and lateral flexion and extension films. Criteria for atlantoaxial subluxation are an anterior atlas—dens

interval of >3 mm or a posterior atlas—dens interval of <14 mm (3). Patients with abnormal C-spine radiographs and/or neuralgia or myelopathy need neu Ebook Preoperative assessment and management (2nd edition): Part 2

rology consultation and possible intervention (halo traction or surgical correction) (6).

11Musculoskeletal and Autoimmune DiseasesParwane s. ParsaThis chapter reviews the preoperative evaluation of patients with musculoskeletal and autoimm

11Musculoskeletal and Autoimmune DiseasesParwane s. ParsaThis chapter reviews the preoperative evaluation of patients with musculoskeletal and autoimm

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