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A case of Behcet's disease posted for surgery: Anaesthetic implications.

Bhalerao PM, Patil VH, Page ND - Indian J Anaesth (2015)

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesiology and Critical Care, B.J. Medical College and Sassoon General Hospitals, Pune, Maharashtra, India.

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Sir, Behcet's disease, a multi-systemic inflammatory process of unknown aetiology is characterised by relapsing episodes of oral aphthous ulcers, genital ulcers, skin lesions and ocular lesions, first described 1937... Ulceration of the oral mucosa, acneiform skin lesions and genital scarring was noted... Diagnostic criteria for Behcet's disease as suggested by Mason and Barnes include: Major criteria-buccal ulceration, genital ulceration, eye lesions and skin lesions... Diagnosis of the disease is made only if three major or two major and two minor criteria are present... Male sex and younger age group are associated with a more severe disease... Since Behcet's disease is an inflammatory process, chronic use of anti-inflammatory and anti-neoplastic drugs is common... Immunosuppressants reduce the activity of the immune system, thus interrupting the inflammation process that causes symptoms of Behcet's disease... Colchicine, an anti-inflammatory medication is found to be beneficial here... It may lead to haematologic, renal and musculoskeletal side effects on long-term therapy... Dangerous parenchymal CNS involvement affecting the brainstem, spinal cord and cerebral hemispheres and non-parenchymal manifestations including intracranial hypertension, aseptic meningitis, cranial neuropathy and cerebrovascular disorders are contraindications for the neuraxial block... However, we preferred spinal anaesthesia considering that CNS involvement was ruled out and the problems associated with difficult airway were far more severe... The main pre-operative anaesthetic concerns in Behcet's disease are therefore scarring of oral mucosa leading to difficult airway, inflammatory involvement of the organ systems, inflammatory response to skin prick and chronic immunosuppressant therapy which could cause renal and haematopoietic side effects... The case was successfully managed after a thorough knowledge of the disease and the anaesthetic implications involved.

No MeSH data available.


Restricted mouth opening
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Figure 1: Restricted mouth opening

Mentions: On examination, he had mild pallor (haemoglobin - 9 g/dl). Mouth opening was one finger breadth [Figure 1] with Mallampati class IV. Ulceration of the oral mucosa, acneiform skin lesions and genital scarring was noted. Echocardiography and magnetic resonance imaging of the brain were normal. The morning dose of oral prednisolone was continued and nil by mouth status and written informed consent confirmed. The patient was posted for hydrocoele and incisional hernia repair under spinal anaesthesia. An intravenous (IV) line was secured using 20 gauge cannula in a single prick and Ringer lactate solution was started. Injection hydrocortisone 50 mg and ondansetron 4 mg were given IV. Subarachnoid block was performed. 3 cc of bupivacaine 0.5% with 30 μg of injection clonidine was administered resulting in a block uptoT6. Pulse rate, blood pressure, respiration, electrocardiogram and oxygen saturation were monitored throughout. Surgery was completed uneventfully.


A case of Behcet's disease posted for surgery: Anaesthetic implications.

Bhalerao PM, Patil VH, Page ND - Indian J Anaesth (2015)

Restricted mouth opening
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4551035&req=5

Figure 1: Restricted mouth opening
Mentions: On examination, he had mild pallor (haemoglobin - 9 g/dl). Mouth opening was one finger breadth [Figure 1] with Mallampati class IV. Ulceration of the oral mucosa, acneiform skin lesions and genital scarring was noted. Echocardiography and magnetic resonance imaging of the brain were normal. The morning dose of oral prednisolone was continued and nil by mouth status and written informed consent confirmed. The patient was posted for hydrocoele and incisional hernia repair under spinal anaesthesia. An intravenous (IV) line was secured using 20 gauge cannula in a single prick and Ringer lactate solution was started. Injection hydrocortisone 50 mg and ondansetron 4 mg were given IV. Subarachnoid block was performed. 3 cc of bupivacaine 0.5% with 30 μg of injection clonidine was administered resulting in a block uptoT6. Pulse rate, blood pressure, respiration, electrocardiogram and oxygen saturation were monitored throughout. Surgery was completed uneventfully.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesiology and Critical Care, B.J. Medical College and Sassoon General Hospitals, Pune, Maharashtra, India.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Sir, Behcet's disease, a multi-systemic inflammatory process of unknown aetiology is characterised by relapsing episodes of oral aphthous ulcers, genital ulcers, skin lesions and ocular lesions, first described 1937... Ulceration of the oral mucosa, acneiform skin lesions and genital scarring was noted... Diagnostic criteria for Behcet's disease as suggested by Mason and Barnes include: Major criteria-buccal ulceration, genital ulceration, eye lesions and skin lesions... Diagnosis of the disease is made only if three major or two major and two minor criteria are present... Male sex and younger age group are associated with a more severe disease... Since Behcet's disease is an inflammatory process, chronic use of anti-inflammatory and anti-neoplastic drugs is common... Immunosuppressants reduce the activity of the immune system, thus interrupting the inflammation process that causes symptoms of Behcet's disease... Colchicine, an anti-inflammatory medication is found to be beneficial here... It may lead to haematologic, renal and musculoskeletal side effects on long-term therapy... Dangerous parenchymal CNS involvement affecting the brainstem, spinal cord and cerebral hemispheres and non-parenchymal manifestations including intracranial hypertension, aseptic meningitis, cranial neuropathy and cerebrovascular disorders are contraindications for the neuraxial block... However, we preferred spinal anaesthesia considering that CNS involvement was ruled out and the problems associated with difficult airway were far more severe... The main pre-operative anaesthetic concerns in Behcet's disease are therefore scarring of oral mucosa leading to difficult airway, inflammatory involvement of the organ systems, inflammatory response to skin prick and chronic immunosuppressant therapy which could cause renal and haematopoietic side effects... The case was successfully managed after a thorough knowledge of the disease and the anaesthetic implications involved.

No MeSH data available.