Systemic sclerosis (SSc), previously known as progressive systemic sclerosis, is a form of scleroderma and a multisystem connective tissue disease which can impact on every aspect of anesthetic care, especially airway management. In this review we outline clinical manifestations and current medical treatment of the disease, and general principles of anesthetizing these patients. We focus on the role of regional anesthesia, including neuroaxial anesthesia, which may serve as a safe alternative to general anesthesia but can be technically challenging. We address concerns regarding abnormal responses to local anesthesia which have previously been reported in patients with SSc, and explore future developments in technology and pharmacology, which may enable regional anesthesia to be performed more successfully and with fewer complications.

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Green Rolex' is a form of ecstasy that has been associated with a number of deaths in the UK and elsewhere. We describe the case of an 18-year-old male who we believe is the only known survivor of severe serotoninergic syndrome associated with this drug. We describe our therapeutic approach with reference to current evidence.