Anesthetic Implications of Relapsing Polychondritis

Burgess, Frederick W.; Whitlock, Warren L.; Davis, Melinda; Patane, Paul S.

doi:10.1097/00000542-199009000-00037

Cited by 19 publications

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“…More extensive involvement may require prolonged endotracheal intubation, external tracheal splinting, or the use of a silastic tube prosthesis or silicon or metal stent [8]. In this patient, the site of the obstructive bronchial lesion (proximal end of the left mainstem bronchus) made any surgical approach impossible.…”

Section: Discussionmentioning

confidence: 99%

“…In addition to medical treatment, if the obstruction is localized to glottic or subglottic regions, tracheostomy may be necessary to save the subject's life [8,9], while localized refractory stenosis or collapse of the tracheobronchial tree may be managed with segmental resection. More extensive involvement may require prolonged endotracheal intubation, external tracheal splinting, or the use of a silastic tube prosthesis or silicon or metal stent [8].…”

Section: Discussionmentioning

confidence: 99%

“…In addition to anti-inflammatory and immunosuppressive drugs, airway lesions may require a variety of interventions, including tracheostomy and bronchial resection [8].…”

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confidence: 99%

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Severe endobronchial obstruction in a girl with relapsing polychondritis: treatment with Nd YAG laser and endobronchial silicon stent

Sacco¹,

Fregonese²,

Oddone³

et al. 1997

Eur Respir J

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Relapsing polychondritis (RP) is an uncommon disorder of unknown aetiology characterized by inflammation and destruction of the cartilaginous structures of many organs, including the tracheobronchial tree. When untreated, there is a high mortality rate, usually from respiratory obstructive complications.An 8 year old white girl, with a previous diagnosis of RP, was referred to our department for evaluation of worsening dyspnoea. Bronchoscopy showed localized inflammatory and fibrotic alterations of the mucosa, leading to severe obstruction of the left mainstem bronchus at its origin. The condition was successfully treated by endoscopic neodymium yttrium aluminium garnet (Nd YAG) laser. Re-evaluation of the patient, 7 months later, demonstrated bronchial stenosis and malacia requiring mechanical dilatation and positioning of an endobronchial silicon stent, which was well-tolerated by the patient. Eur Respir J 1997; 10: 494-496 Relapsing polychondritis is an uncommon inflammatory disease of unknown cause affecting cartilages in many organs and systems [1,2]. This disorder is manifested by recurrent and, generally, progressive inflammation of the cartilaginous portion of the external ear, joints, cardiovascular system and respiratory tract [2,3]. At the airway level, the extent of the disease may vary and all cartilage-containing structures can be affected [4]. Although onset of relapsing polychondritis may vary, the majority of cases appear between the ages of 40 and 60 yrs, with an equal sex distribution and no known familial predisposition [2][3][4].The most widely-accepted hypothesis for the pathogenesis of polychondritis is that a primary or secondary immune reaction against mucopolysaccharide components of cartilage ground substance results in severe inflammatory changes leading to the destruction of cartilage [4,5]. Histologically, the characteristic abnormalities are: 1) focal or diffuse loss of basophilic staining, indicating depletion of proteoglycans from the cartilage matrix; 2) inflammatory infiltrates, consisting predominantly of mononuclear cells and plasma cells; and 3) destruction of the cartilage with loss of chondrocytes [2][3][4][5].When untreated, this disorder is associated with a high mortality rate, usually from respiratory and cardiovascular complications, such as obstructive pneumonia, aortic valve disease and aortic aneurysm [4][5][6][7]. In addition to anti-inflammatory and immunosuppressive drugs, airway lesions may require a variety of interventions, including tracheostomy and bronchial resection [8]. Case reportAn 8 year old Caucasian girl was referred to our department for evaluation of worsening dyspnoea. At another institution, a diagnosis of relapsing polychondritis had been made 18 months previously, on the basis of the presence of: 1) nasal chondritis, resulting in collapse of the nasal bridge with a saddle deformity; 2) clinical, roentgenographic and endoscopic demonstration of inflammatory alteration of cartilages of the proximal trachea; 3) histological abnormality ...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Severe endobronchial obstruction in a girl with relapsing polychondritis: treatment with Nd YAG laser and endobronchial silicon stent

Sacco¹,

Fregonese²,

Oddone³

et al. 1997

Eur Respir J

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“…Accordingly, radiographic and bronchoscopic examinations may provide incorrect information for determining the degree of tracheal obstruction, as dynamic airway collapse occurs during respiration. However, inspiratory and expiratory flow-volume loops are useful in predicting the functional degree of intrathoracic and extrathoracic obstruction [5]. In this case, the patient demonstrated severe airway obstruction on flow-volume loop that was well-correlated with her severe respiratory symptoms, including orthopnea.…”

Section: Discussionmentioning

confidence: 99%

Anesthetic experience of a patient with relapsing polychondritis -A case report-

Kim

Choi

et al. 2012

Korean J Anesthesiol

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Relapsing polychondritis is a rare disease characterized by progressive inflammation and destruction of cartilaginous structures such as ears, nose, and tracheolaryngeal structures. As a result, tracheolaryngeal involvement makes anesthetic management a challenge. Anesthetic management of a patient with relapsing polychondritis may encounter airway problems caused by severe tracheal stenosis. We present the case of a 60-year-old woman with relapsing polychondritis who underwent wedge resection of the stomach under epidural analgesia. Thoracic epidural blockade of the T4-10 dermatome was achieved by epidural injection of 7 ml of 0.75% ropivacaine and 50 µg of fentanyl. The patient was tolerable during the operation. We suggest that epidural analgesia may be an alternative to general anesthesia for patients with relapsing polychondritis undergoing upper abdominal surgery.

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“…Dyspnea, a common symptom during normal pregnancy, may indicate airway compromise in RP. 10 The increase in cardiac output and the softening of the media of the vasculature may increase the risk of aneurysmal dilatation of large blood vessels, such as the aorta.…”

Section: 2mentioning

confidence: 99%

Anesthetic management of the parturient with relapsing polychondritis

Douglas

Ensworth

2005

Can J Anesth/J Can Anesth

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Purpose: To present the anesthetic management of a parturient with relapsing polychondritis (RP) and to discuss the anesthetic implications of RP. Clinical features:A 28-yr-old primiparous woman with known RP, spondyloarthropathy and fibromyalgia presented for urgent Cesarean delivery for breech presentation and prodromal labour. Her pregnancy had been complicated by a hospital admission for an exacerbation of her RP as manifested by hoarseness, increased pain and tenderness of her left ear and nasal bridge cartilages, sinusitis with bloody nasal discharge and increased pain and tenderness of the anterior tracheal rings. Epidural anesthesia was administered for the Cesarean delivery. Her intraoperative and postoperative course was uneventful. Close cooperation among obstetricians, anesthesiologists and rheumatologists resulted in a successful outcome. Conclusion:Relapsing polychondritis is a syndrome with important anesthetic implications. Multidisciplinary cooperation is essential in managing these high risk parturients.

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Anesthetic Implications of Relapsing Polychondritis

Cited by 19 publications

References 0 publications

Severe endobronchial obstruction in a girl with relapsing polychondritis: treatment with Nd YAG laser and endobronchial silicon stent

Severe endobronchial obstruction in a girl with relapsing polychondritis: treatment with Nd YAG laser and endobronchial silicon stent

Anesthetic experience of a patient with relapsing polychondritis -A case report-

Anesthetic management of the parturient with relapsing polychondritis

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