Anesthetic management of the parturient with relapsing polychondritis

Abstract

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.

Management of preeclampsia with severe features in a patient with relapsing polychondritis affecting the tracheobronchial tree

“…Neuraxial anaesthesia is likely the safest technique in patients with RP as this avoids unnecessary airway manipulation in patients who may already have compromised airway patency and altered ventilatory mechanics [7,8]. If GA is necessary, it is worth preparing for the potential to experience acute airway obstruction due to inflammatory oedema and/or dynamic airway collapse (both worsened by the presence of preeclampsia) [3].…”

“…Gestation is usually not recommended in patients with severe respiratory tract involvement [4]. However, a significant number of pregnancies will progress uneventfully and in such patients, there is no preferred mode of birth (in view of RP), and management should be based on obstetric considerations [8].…”