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Scleroderma (Effects on anaesthesia (Resp (Pulmonary fibrosis: Reduced…
Scleroderma
Effects on anaesthesia
Skin
Reduced mandibular motion and reduced mouth opening from tight skin (potential difficult airway, FOI may be req to facilitate intubation through small aperture)
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Raynauds phenomenon (possible difficult IV, concern with Raynauds and ART lines, potentially difficult regional anaes, must attempt to avoid peripheral vasocon)
CVS
Chronic HTN and vasomotor instability - reduced vascular volume (risk hypotension at induction). Pericardial effusions, myocardial fibrosis, dilated cardiomyopathy, CCF
GI
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Malabsorption (Coagulopathy risk (vit K malabsorption) - regional may be CI, anaemia risk)
Resp
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Reduced diffusion capacity and vulnerability to hypoxaemia (difficulty oxygenating and ventilating (may require higher fiO2 and pressures
Pulmonary HTN (avoid factors which increase PVR -acidosis, hypoxaemia) - may progress to cor pulmonale
May benefit from post op HDU, benefit from chest physio, consider regional
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Classification
Limited
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Associated with CREST syndrome (Calcinosis, Raynauds, Oesophageal hypomotility, sclerodactyl, telangiactasia)
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