Download Systemic Lupus Erythematosus

Q: Why does seal have scars on
his face?
A: Discoid Lupus
Systemic Lupus Erythematosus
Angelique Davis
SLE: Introduction
 An autoimmune,
 Occurs in about 1:1000
multisystem chronic
inflammatory disease with
flares and remissions
 Antinuclear antibodies,
targeting DNA, RNA, and
cell membrane structures,
are present in more than
95% of SLE patients
women and more often in
young childbearing aged
female patients
 9:1 female to male ratio
 Occurs more often in
women of Asian or
African descent
 Symptoms vary from mild
to severe
Diagnosing SLE, must have at least
4 of the below criteria:
Clinical Manifestations of SLE
 Macular facial rash,
only present in 1/31/2 of patients
 Migratory polyarthritis
and dermatitis
 Polyarthritis that
causes out of
proportional pain
Unknown (2013). SLE face. Retrieved from http://drcamisasblog.com/wpcontent/uploads/2013/09/SLEFace.png
Systemic Manifestations of SLE
 SLE affects
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CNS
Heart
Lungs
Kidneys
Liver
Neuromuscular
skin
Nursing School. (2007, ). Medical Surgical Nursing Mneumonics [Blog post].
Retrieved from http://studentnurses3.blogspot.com/p/medical-surgical-nursingmnemonics.html
SLE: CNS involvement
 Occurs in 1/3-1/2 of
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patients
Due to vasculitis
Atypical migraines
Anxiety
Mild depression
 Mild cognitive
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impairment
Polyneuropathy
Myelitis
Seizures
Stroke
SLE: Heart
 Most common signs and symptoms are
pericarditis
 Causing chest pain, friction rub, ECG
changes, and pericardial effusion
 ECG changes include Sinus Tachycardia,
Atrial Fibrillation, A-V conduction blocks,
prolonged QT intervals
SLE: Lungs
 Lupus pneumonia causes:
 Diffuse pulmonary infiltrates
 Pleural effusions
 Dry cough
 Dyspnea
 Arterial hypoxemia
 Pleuritis
 Late sign “shrinking lung syndrome”
 Decreases total lung capacity and volume
 PFT’s show a restrictive lung disease
 Decreased diffusion capacity
SLE: Kidneys
 Lupus nephritis is present in 60% of patients
due to the disease itself and treatment
 Hallmark symptom is glomerulonephritis with
proteinuria and less common hematuria
 Proteinuria, hypertension and decreased
creatinine clearance are usual
manifestations of lupus nephritis
 Anemia
SLE: Musculoskeletal
 Non-erosive arthritis
 Osteoporosis
 Atlanoaxial subluxation
 May need fiberoptic intubation
 Epiglottitis
 Rheumatoid type nodules on vocal cords
 Cricoartenoiditis
 With active SLE symptoms, one may watch for postintubation subglottic stenosis
SLE: Liver
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LFTs are abnormal in about 30% of patients
Anemia
Leukopenia
Thrombocytopenia
Antiphospholipid syndrome
SLE: Skin
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Rash
Alopecia
Photosensitivity
Pathology of mucous membranes
 Oral or nasopharyngeal ulcers
Anesthetic Considerations
 No technical “best” way to plan an anesthetic
for SLE patients.
 Very much depends on current status of SLE
patient and organ involvement
 Medication regimen
Pharmacotherapy for SLE
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Carrillo, S. T., Gantz, E., Kaye, R. J., & Kaye, A. D. (2012). Anesthetic
considerations for the patient with systemic lupus erythematosus. M.E.J.
Anesth, 21(4), 483-492.
Anesthesia Management for SLE
 Perioperative assessment
 CXR, PFTs, Echo, Labs, ECG
 Neck ROM, mucosal, laryngeal, and vocal cord involvement
 Consultations
 Intraoperative Management
 Depends on findings from pre-op assessment
 If patient taking cyclophosphamide  lengthens response time to SCh
 Postoperative Management
 If renal or liver organ involvement, drugs may accumulate, causing
prolonged sedation or paralysis. This may lead to an increased
recovery time
 May want to consider medications that are not organ dependent
on elimination, i.e. remifentanil or cisatracurium
Summary of SLE
 SLE is an autoimmune multisystem disease
 SLE has exacerbations and remissions
 Anesthetic management will vary according to the
severity of organ involvement and medication
regimen of the SLE patient
 SLE patients with organ involvement are at higher
risk of complications.
 Maintain a low threshold for ordering labs, ECGs,
etc. or insertion of invasive monitoring devices
References
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Barash, P. G., Cullen, B. F., Stoelting, R. K., Cahalan, M. K., Stock, M. C., & Ortega,
R. (2013). Clinical anesthesia (7th ed.). Philadelphia: Lippincott Williams & Wilkins.
Ben-Menacham, E. (2010). Systemic lupus erythematosus: a review for
anesthesiologists. Anesthesia & Analgesia, 111(3), 665-676.
Carrillo, S. T., Gantz, E., Kaye, R. J., & Kaye, A. D. (2012). Anesthetic considerations
for the patient with systemic lupus erythematosus. M.E.J. Anesth, 21(4), 483-492.
Hines, R. L., & Marschall, K. E. (2012). Stoelting’s Anesthesia and Co-existing
disease (6th ed.). Philadelphia, PA: Elsevier.
Hochberg, M. C. (1997). Arthritis Rheum. 40(9), 1725.
Nursing School. (2007, ). Medical Surgical Nursing Mneumonics [Blog post].
Retrieved from http://studentnurses3.blogspot.com/p/medical-surgical-nursingmnemonics.html
Unknown (2013). SLE face. Retrieved from http://drcamisasblog.com/wpcontent/uploads/2013/09/SLEFace.png