Ankylosing spondylitis
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Transcript of Ankylosing spondylitis
Anesthesia and Ankylosing Spondylitis
Mark Wagner CRNA, M.S.
Ankylosing Spondylitis
Ankylosis - Stiffening or fixation of a joint as a result of a disease process, with fibrous or bony union across the joint; fusion.
Spondylitis - Inflammation of one or more of the vertebrae.
Spondylosis - Ankylosis of the vertebrae.
Overview: Rheumatic, autoimmune
Inflammation of spine/Sacroiliac joints/Pelvis
Strong genetic predisposition
- Autosomal dominant; HLA B27 genotype.
Males > Females (3:1)
Diagnosis of AS
Schober test
Gaenslen test
Neuro evaluation
Radiographic evidence
AS Pathophysiology
“Bamboo Spine”
Ankylosing Spondylitis
Sacroiliac Involvement
Iritis or Anterior Uveitis
Inflammation of the eye
Signs and symtoms:
-Redness, pain, sensitivity to light and skewed vision.
Treatment:- Cortcosteroid eyedrops
AS Treatment
NSAIDS (Indomethacin)
Sulphasalazine
Exercise/Physical therapy
Surgery
- Hip/shoulder arthroplasty, osteotomy, decompression and fusion.
Spondylolysis
Term used to describe
the presence of a “defect”
or stress fracture in the
posterior arch of the
vertebrae. It occurs at the
lumbo-sacral junction
(L5/S1) in about 85% of
cases.
Respiratory Abnormalities
Restrictive disease
compliance
vital capacity
Upper lobe fibrosis
Cricoarytenoid Arthritis
Cricoarytenoid joints
Abduct and adduct
vocal cords
Hoarseness
RD and stridor
TMJ Ankylosis
Limited movement in 10% of pts.
In advanced disease, 30-40% affected
May progress to complete ankylosis and inability to open mouth
Awake fiber-optic nasal intubation should be considered
Cardiovascular Abnormalities
Aortic insufficiency/Aortitis
Cardiomyopathy
Angina
Conduction abnormalities
Neurological Abnormalities
Spinal stenosis
Radicular pain/Paresthesias
Cauda equina syndrome
Vertebral fractures
Pre-Operative Evaluation
H+P
- Activity tolerance
AIRWAY!- Cervical ROM, MO
ability to lie flat
Chest/spine films
- Severity/location
Pre-Operative Evaluation
Pulmonary function- PFT’s, ABG, breath sounds
Cardiovascular- Cardiac anomalies, 2-D ECHO,
stress test, cath results
Labs- CBC, Chem 7, Coags, T+C
AS and Anesthesia
Awake fiber-optic intubation
Trach under L.A.
Regional anesthesia-Spinal, Epidural, Caudal
Positioning
Questions?