ankylosing spondylitis
TRANSCRIPT
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Anesthesia and Ankylosing Spondylitis
Mark Wagner CRNA, M.S.
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Ankylosing Spondylitis
Ankylosis - Stiffening or fixation of a joint as a result of a disease process, with fibrous or bony union across the joint; fusion.
Spondylitis - Inflammation of one or more of the vertebrae.
Spondylosis - Ankylosis of the vertebrae.
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Overview: Rheumatic, autoimmune
Inflammation of spine/Sacroiliac joints/Pelvis
Strong genetic predisposition
- Autosomal dominant; HLA B27 genotype.
Males > Females (3:1)
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Diagnosis of AS
Schober test
Gaenslen test
Neuro evaluation
Radiographic evidence
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AS Pathophysiology
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“Bamboo Spine”
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Ankylosing Spondylitis
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Sacroiliac Involvement
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Iritis or Anterior Uveitis
Inflammation of the eye
Signs and symtoms:
-Redness, pain, sensitivity to light and skewed vision.
Treatment:- Cortcosteroid eyedrops
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AS Treatment
NSAIDS (Indomethacin)
Sulphasalazine
Exercise/Physical therapy
Surgery
- Hip/shoulder arthroplasty, osteotomy, decompression and fusion.
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Spondylolysis
Term used to describe
the presence of a “defect”
or stress fracture in the
posterior arch of the
vertebrae. It occurs at the
lumbo-sacral junction
(L5/S1) in about 85% of
cases.
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Respiratory Abnormalities
Restrictive disease
compliance
vital capacity
Upper lobe fibrosis
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Cricoarytenoid Arthritis
Cricoarytenoid joints
Abduct and adduct
vocal cords
Hoarseness
RD and stridor
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TMJ Ankylosis
Limited movement in 10% of pts.
In advanced disease, 30-40% affected
May progress to complete ankylosis and inability to open mouth
Awake fiber-optic nasal intubation should be considered
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Cardiovascular Abnormalities
Aortic insufficiency/Aortitis
Cardiomyopathy
Angina
Conduction abnormalities
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Neurological Abnormalities
Spinal stenosis
Radicular pain/Paresthesias
Cauda equina syndrome
Vertebral fractures
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Pre-Operative Evaluation
H+P
- Activity tolerance
AIRWAY!- Cervical ROM, MO
ability to lie flat
Chest/spine films
- Severity/location
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Pre-Operative Evaluation
Pulmonary function- PFT’s, ABG, breath sounds
Cardiovascular- Cardiac anomalies, 2-D ECHO,
stress test, cath results
Labs- CBC, Chem 7, Coags, T+C
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AS and Anesthesia
Awake fiber-optic intubation
Trach under L.A.
Regional anesthesia-Spinal, Epidural, Caudal
Positioning
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Questions?