Faculty of Public Health and Health CareBook 8.4 · Medical and Clinical Diagnostic Activities

FRI-2G.309-1-MCDA-05

ANESTHESIA FOR ENDOSCOPY IN A PATIENT WITH LUPUS - CLINICAL CASE

Assoc. Prof. Teodora Nedeva, MD, PhD

Department of Medical, Clinical and Diagnostical Activities Univesity of Ruse “Angel Kanchev”

Abstract

Systemic lupus erythematosus (SLE) is well known autoimmune connective tissue disease with various clinical presentation. The severity of the disease is widely ranging and sometimes may be potentially fatal. In some of the cases may propose serious challenges to the anaesthesiology team. It is because of the heterogenity of the disease and the multiple organ damage (pulmonary involvement, with difficult airway; cardiovascular and neurologic complications), complex treatment regimens with current medications taken and coagulopathy (anaemia, thrombocytopenia, leukopenia, thromboembolism). The good outcome of anaesthesia mostly depends on careful preoperative patient’s evaluation either of clinical features, laboratory tests, airway evaluation, drugs regimens Anaesthetic management plan should take into account the severity of the disease, anatomic abnormalities present, unexpected difficult airway the potential drug interactions and patient position on the table. Sometimes multidisciplinary approach is absolutely necessary. The most important in perioperative management of lupus’ patient is the individual based approach as there are many anaesthesia challenges for the different patients and types of surgeries. The paper reviews a clinical case of a female patient with lupus admitted in hospital for colonoscopy. The anaesthesia was intravenous and underwent without any complications. It was due to the mild form of patient’s lupus, the careful preoperative assessment and the shortness of the colonoscopy and anaesthesia.

Keywords

Anaesthesia, Criteria, Complications, Endoscopy, Systemic Lupus Erythematosus

REFERENCES

Aringer M., N. Leuchten, S. Johnson, (2020), New Criteria for Lupus, Curr Rheumatol Rep., May 13, 22(6):18. Doi 10.1007/s11926-020-00896-6.
Cassidy J.T. (2008) Systemic lupus erythematosus, juvenile dermatomyositis, scleroderma, and vasculitis // Firestein G.S., Budd R.C., Harris E.D. Jr., McInnes I.B., Ruddy S., Sergent J.S., eds. Kelley’s Textbook of Rheumatology. - 8th ed. - Philadelphia, PA: Saunders Elsevier,- P. 1677- 1681.
Ghate T., Pahuja H., Naitam R. et all. (2023). Anaesthetic management of Systemic Lupus Erythematosus - Clinical series, Journal of Cardiovascular Disease Research, Vol.14, Issue 12, p.1951- 1957.
Hargraves M.M. (1969) Discovery of the LE cell and its morphology. Mayo Clin Proc., 44 (9). - P. 579-599.
Hochberg M.C. (1991)The history of lupus erythematosus. Md Med J., 40 (10). -P. 871-873.
Rivest C., Lew R.A., Welsing P.M., et al. (2000) Association between clinical factors, socio- economic status, and organ damage in recent-onset systemic lupus erythematosus. J Rheu-matol. 27 (3), P. 680-684
Sergent J.S., eds. (2008) Kelley’s Textbook of Rheumatology. 8th ed. Philadelphia, PA: Saunders Elsevier, P. 1263-1296
Sharon C., E. Gantz, A. Baluch, et all, (2012) Anesthetic Considerations for the Patient with Systemic Lupus Erythematosus, MEJ Anesth 21 (4), P. 483-492