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Ebook Preoperative assessment and management (2nd edition): Part 2

(BQ) Part 2 book "Preoperative assessment and management" presentation of content: Musculoskeletal and autoimmune diseases, miscellaneous issues, the pregnant patient for nonobstetric surgery, the pediatric patient, anesthetic specific issues, perioperative management issues, organizational infrastructure of a preoperative evaluation center,. and other contents. | P1: KUF/OVY P2: PCX/OVY GRBT273-11 Sweitzer-3499G QC: OVY GRBT273-Sweitzer-v2.cls Printer: RRD December 3, 2007 18:24 11 Musculoskeletal and Autoimmune Diseases Parwane S. Parsa This chapter reviews the preoperative evaluation of patients with musculoskeletal and autoimmune diseases. The autoimmune diseases discussed in this section include rheumatoid arthritis, ankylosing spondylitis, systemic lupus erythematosus, and scleroderma. Other musculoskeletal diseases included in this chapter are osteoarthritis and kyphoscoliosis. Marfan syndrome and other inherited connective tissue diseases are reviewed. These entities are distinguished by variable disease severity and frequent multisystem effects requiring careful preoperative investigation. This chapter discusses strategies to identify and treat patients with consequent pulmonary and cardiac involvement and also reviews newer therapies used to delay disease progression. RHEUMATOID ARTHRITIS Rheumatoid arthritis (RA), a common and debilitating autoimmune disease, affects up to 1% of the population, typically ranging in age from 40 to 70 years. Incidence of the disease is greater in females than in males (ratio of 2.5:1) (1). In addition to the characteristic joint inflammation, multiple organ systems are impacted by the disease, requiring careful evaluation. General Patients with RA may report fatigue, malaise, weight loss, and fever. Arthropathy The disease involves multijoint inflammation and morning stiffness of both small and large joints of the extremities. The temporomandibular joint, cervical spine, and cricoarytenoid cartilages are frequently affected. Patients may experience limited neck and jaw mobility or hoarseness. The arthropathy is progressive and disabling. Neurologic Sensory peripheral neuropathy associated with vasculitis and nerve entrapment occurs with RA. Cardiac Pericardial effusion, aortic insufficiency, and conduction abnormalities are common. The incidence of myocardial ischemia .