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Anesthesia and Systemic Sclerosis (SSc, or Scleroderma)

Medications for Scleroderma, Arthritis, Autoimmune and Rheumatic Diseases

This page was written by Janey Willis. See Disclaimer.
Overview
Avoid Steroids, Prednisone
Manage Cardiac and Vascular Issues
Manage Gastrointestinal Issues
Case Studies

Overview of Anesthesia Considerations for Systemic Scleroderma

Scleroderma can affect any part of the body. Look for skin, vascular, gastrointestinal, internal organ, and CNS involvement.

Medical Equipment by Shelley EnszCare 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)

Avoid Corticosterois, Prednisone

Avoid use of steroids in systemic scleroderma patients!

Corticosteroids strongly increase
the short-term risk of developing
scleroderma renal crisis!
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)

Manage Cardiac and Vascular Issues

No epi to avoid Raynaud's. Increased risk of dysrhythmia and blood clots. Keep patients very warm at all times.

Attack of Raynauds, ISN Photo RepositoryAvoiding 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)

Manage Esophageal and Bowel Involvement

High risk of reflux, and bowel blockage post-surgically.

Heartburn must be well-managed. There is greater risk of severe constipation or bowel blockage following surgery, due to weakened peristalsis. (Also see Bowel Involvement, and Reflux/Heartburn)

Case Studies

Thoracic epidural anaesthesia worked good.

Thoracic epidural anaesthesia for thoracotomy, oesophageal myotomy and cystotomy-capitonnage in an elderly patient wıth achalasia due to scleroderma. This anesthetic technique provided good intraoperative relaxation followed by an uneventful recovery and eliminated the need for other postoperative analgesics. Acute Pain Management.

Combined Spinal Epidural Anesthesia may be useful.

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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