Espondilite anquilosante e anestesia

Carlos Rogério Degrandi Oliveira

doi:10.1590/S0034-70942007000200011

Review Article

Espondilite anquilosante e anestesia

Ankylosing spondylitis and anesthesia

Carlos Rogério Degrandi Oliveira

http://dx.doi.org/10.1590/S0034-70942007000200011 Braz J Anesthesiol, vol.57, n2, p.214-222, 2007

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Resumo

JUSTIFICATIVA E OBJETIVOS: A espondilite anquilosante (EA) é uma doença inflamatória crônica das articulações, incluída no grupo das espondiloartropatias soronegativas. A característica principal dessa doença é a fusão óssea da coluna vertebral que leva à perda permanente da flexibilidade do dorso e do pescoço. Outras grandes articulações e tecidos conectivos poderão estar afetados pelo processo inflamatório. A EA acomete principalmente homens entre 20 e 40 anos; é rara após os 50 anos. As mulheres correspondem somente à minoria de pacientes. Há pouca informação sobre a EA na literatura anestésica. O objetivo deste artigo foi revisar aspectos da EA de interesse para o anestesiologista, permitindo um adequado manuseio perioperatório. CONTEÚDO: Estão definidas as características da espondilite anquilosante quanto à clínica e a conduta anestésica. CONCLUSÕES: Os pacientes com doenças crônicas da coluna vertebral apresentam desafios específicos para o anestesiologista. O manuseio da via aérea e o acesso ao neuroeixo poderão ser difíceis. Preferência tem sido dada à anestesia geral, mesmo com via aérea difícil reconhecida, evitando-se a anestesia no neuroeixo. O grau de envolvimento da coluna cervical determinará o quanto poderá ser difícil a intubação traqueal. Cuidado especial deve ser tomado para evitar a manipulação excessiva da coluna cervical, que poderia levar ao trauma da medula espinhal.

Palavras-chave

ANESTESIA, Geral, DOENÇAS

Abstract

BACKGROUND AND OBJECTIVES: Ankylosing spondylitis (AS) is a chronic inflammatory disease of the joints, included in the group of seronegative spondyloarthropathies. Its main characteristic is the fusion of the bones in the spine, which causes loss of flexibility of the back and neck. Other large articulations and connective tissues can be affected by the inflammatory process. It affects mainly men between the ages of 20 and 40; it is rare after the age of 50. Women represent a minority of patients. There is little information about AS in the anesthetic literature. The objective of this article was to review the characteristics of AS pertaining anesthesiology for an adequate perioperative handling. CONTENTS: The clinical characteristics of ankylosing spondylitis pertaining to the anesthetic conduct are reviewed. CONCLUSIONS: Patients with chronic diseases of the spine represent specific challenges to the anesthesiologist. Handling of the airways and the access to the neuroaxis can be difficult. Most anesthesiologists prefer to use general anesthesia, avoiding the neuroaxis, in those patients, despite the presence of difficult airways. The degree of spine involvement will determine how difficult the tracheal intubation might be. Special care should be taken to avoid excessive manipulation of the neck, which could cause trauma to the spinal cord.

Keywords

ANESTHESIA, general, DISEASES

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Espondilite anquilosante e anestesia

Ankylosing spondylitis and anesthesia

Carlos Rogério Degrandi Oliveira

Resumo

Palavras-chave

Abstract

Keywords

References

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