Musculoskeletal disorders

Musculoskeletal disorders

Muscular disorders have serious implications and require a tailored anaesthetic approach. They include muscular dystrophies, myotonic dystrophy and myasthenia gravis and a personal or family history of malignant hyperpyrexia. Rheumatoid arthritis can lead to an unstable cervical spine with the possibility of spinal cord injury during intubation. Therefore, flexion and extension lateral cervical spine radiographs should be obtained in symptomatic patients ( Figures 21.7 and 21.8 ). Assessment of the severity of renal, - cardiac, valvular and pericardial involvement as well as restrictive lung disease should be carried out. Rheumatologists will advise on steroids and disease-modifying drugs so as to - balance immunosuppression (chance of infections) against the need to stabilise the disease perioperatively (stopping disease- modifying drugs can lead to flare-up of the disease). In patients with ankylosing spondylitis, in addition to the problems discussed above, techniques of spinal or epidural anaesthesia are often challenging. Patients with systemic lupus erythematosus may e xhibit a hypercoagulable state along with - airway di ffi culties.