Table 3 Disease-specific complications that may affect use of analgesia and anesthesia
From: Managing pregnancy in inflammatory rheumatological diseases
| Disease | Complications that may affect use of analgesia and anesthesia |
|---|---|
| Systemic lupus erythematosus | Pericarditis or valvular abnormalities |
| Pulmonary hypertension, pleural effusions, or lupus pneumonitis | |
| Peripheral neuropathies, central nervous system dysfunction (seizures), or psychological problems | |
| Hematological abnormalities (anemia, thrombocytopenia, or coagulopathy) | |
| Lupus nephritis | |
| Antiphospholipid syndrome | Coexisting autoimmune disease, secondary organ involvement, and thrombotic phenomena, including pulmonary |
| hypertension | |
| Anticoagulation | |
| Rheumatoid arthritis | Cervical spine involvement (exclude atlantoaxial anterior subluxation and avoid excessive manipulation of neck during general anesthesia) |
| Hip disease that might prevent vaginal delivery | |
| Pleural/pericardial effusions and pulmonary parenchymal involvement | |
| Ankylosing spondylitis | Assess presence of extra-articular (cardiopulmonary) features and use of opiate analgesics |
| Temporo-mandibular joint dysfunction, cervical and lumbar spine (for general, epidural, or spinal anesthesia), and hip | |
| involvement (for vaginal delivery) | |
| Systemic sclerosis | Renal disease, systemic hypertension, pulmonary hypertension, or cardiac dysfunction |
| Assess peripheral pulses, peripheral venous access, extent of Raynaud phenomenon, and skin involvement | |
| Vasculitis | Organ ischemia (cardiac, renal, cerebral, and limb) and intravascular volume |
| Monitor hypertension and end organ complications or thrombosis |