🏳️🌈Preoperative abnormalities
1. Symptoms of the sicca syndrome include dryness of the eyes and skin.
2. Check for associated RA, SLE, scleroderma, the polymyositis, polyarteritis nodosa, chronic active hepatitis, and Grave’s disease.
3.Lung / airway : desiccation of the nose and bronchial tree, obstructive airways disease, interstitial lung disease
4.sensory / motor neuropathy may occur and CNS lesions have been described.
5.The patient may be taking corticosteroids or occasionally immunosuppressive agents.
🏳️🌈Anaesthetist’s concerns
1. Sometimes gross swelling of the salivary glands may make mask anaesthesia difficult.
2.The problems of pulmonary disease, if present.
3.The dry eyes are susceptible to damage during anaesthesia.
4.Allergy to antimicrobial agents, particularly penicillin, cephalosporins and trimethoprim
Management
1. careful assessment of the primary disease, and of any pulmonary involvement.
2. Drying agents should be avoided if possible.
3. The eyes should be protected with pads.
4. Anaesthetic gases should be humidified.
5. Steroid supplements may be required.
6. Care should be taken when prescribing antimicrobial agents