Anesthesia for Rheumatoid Arthritis (RA) Patient

RA is an autoimmune disorder characterized by symmetric, erosive synovitis which occurs in any joints including cartilaginous joints. The anesthesia-related problems of RA are (1) compromised cardiac, pulmonary and renal functions due to RA involvement, (2) high incidence of ischemic heart disease, cancer, infectious disease and anemia due to RA pathology or anti-RA drugs including steroids, and (3) difficult airway mainly caused by ankylosis of cervical spine. There are no specially suitable anesthesia agents for RA, that means any agents can be used if the precaution is taken against high susceptibility of RA patients to anesthetic drugs.As for the difficult airway we have been using laryngeal mask airway or fiberoptic intubation method with mouth mask, in which fiberoptic naso-tracheal intubation is performed on patients who are anesthetized, paralyzed and ventilated with a mask covering only the mouth. This method frees the patients completely from discomfort accompanying to awake intubation and allows anesthesiologists to take as much time as needed for intubation.