An Update on Systemic Sclerosis and its Perioperative Management.

Autor:	Carr ZJ; Department of Anesthesiology, Yale New Haven Hospital, New Haven, CT 06510 USA.; Yale University School of Medicine, New Haven, CT 06510 USA., Klick J; Department of Anesthesiology, University of Vermont Medical Center, Burlington, VT 05405 USA.; Larner College of Medicine at The University of Vermont, Burlington, VT 05405 USA., McDowell BJ; Department of Anesthesiology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA 17033 USA.; Penn State School of Medicine, Hershey, PA 17033 USA., Charchaflieh JG; Department of Anesthesiology, Yale New Haven Hospital, New Haven, CT 06510 USA.; Yale University School of Medicine, New Haven, CT 06510 USA., Karamchandani K; Department of Anesthesiology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA 17033 USA.; Penn State School of Medicine, Hershey, PA 17033 USA.
Jazyk:	angličtina
Zdroj:	Current anesthesiology reports [Curr Anesthesiol Rep] 2020; Vol. 10 (4), pp. 512-521. Date of Electronic Publication: 2020 Aug 29.
DOI:	10.1007/s40140-020-00411-8
Abstrakt:	Purpose of Review: Systemic sclerosis or scleroderma (SSc) is a systemic, immune-mediated disease characterized by abnormal cutaneous and organ-based fibrosis that results in progressive end-organ dysfunction and decreased survival. SSc results in significant challenges for the practicing anesthesiologist due to its rarity, multi-system involvement, and limited evidence-based guidance for optimal perioperative care. In this update, we briefly discuss the recent evidence on the pathophysiology and current management of SSc, review the anesthesia-related literature, and extrapolate these observations into an optimal perioperative strategy for the care of SSc patients. Recent Findings: Evidence shows that patients with SSc demonstrate an increased risk for perioperative myocardial infarction, high rates of interstitial lung disease, pulmonary arterial hypertension, neurological disease, gastric dysmotility disorders, and challenging airway management, all findings that may result in suboptimal perioperative outcomes. Summary: Advances in SSc medical management have resulted in improved survival, likely increasing the number of patients who will be exposed to perioperative care. Optimal perioperative management and risk stratification should expand beyond the well-described airway challenges and consider numerous systemic manifestations of systemic sclerosis such as pulmonary arterial hypertension, interstitial lung disease, and cardiac sequelae. Competing Interests: Conflicts of InterestNone of the authors has any potential conflicts of interest to disclose. (© Springer Science+Business Media, LLC, part of Springer Nature 2020.)
Databáze:	MEDLINE
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