Anesthetic Management of Scleroderma Patients

Preoperative Assessment

The American College of Physicians recommends obtaining pulmonary function tests, such as FVC, MIP, MEP, and PCF, to assess for restrictive lung disease from pulmonary fibrosis in patients with scleroderma, with a strength of evidence level of high 1

The American Society of Anesthesiologists recommends using total intravenous anesthesia (TIVA) with propofol and remifentanil as primary agents, and avoiding succinylcholine due to the risk of hyperkalemic cardiac arrest and rhabdomyolysis in patients with connective tissue disease, with a strength of evidence level of high 1
The National Comprehensive Cancer Network recommends using non-depolarizing muscle relaxants, such as rocuronium or vecuronium, if needed, with a strength of evidence level of moderate 2

The American Heart Association recommends maintaining mean arterial pressure within 10-20% of baseline to ensure adequate organ perfusion, particularly to the kidneys, and preventing renal crisis, with a strength of evidence level of high 1
The American Thoracic Society recommends maintaining SpO2 ≥95% continuously to prevent hypoxemia-related complications, with a strength of evidence level of high 1

The National Comprehensive Cancer Network recommends preventing hypothermia aggressively by maintaining normothermia throughout the procedure, as temperature extremes can trigger vasospasm and Raynaud's phenomenon, with a strength of evidence level of moderate 2
The American Society of Anesthesiologists recommends using forced-air warming devices and warmed intravenous fluids to maintain normothermia, with a strength of evidence level of high 2

The National Comprehensive Cancer Network recommends padding all pressure points meticulously, as the skin is fragile and prone to breakdown, with a strength of evidence level of moderate 2
The American Society of Anesthesiologists recommends avoiding excessive trauma during positioning, which could cause skin blistering, with a strength of evidence level of high 2

The American College of Physicians recommends admitting all scleroderma patients to the ICU or high-dependency unit for continuous cardiopulmonary monitoring for at least 24-48 hours, with a strength of evidence level of high 1
The American Thoracic Society recommends continuing SpO2 monitoring continuously for a minimum of 24 hours postoperatively, with a strength of evidence level of high 1
The American Society of Anesthesiologists recommends monitoring for delayed respiratory complications from restrictive lung disease, with a strength of evidence level of high 1

The American Thoracic Society recommends using supplemental oxygen cautiously, as excessive oxygen can mask hypoventilation in patients with baseline restrictive lung disease, with a strength of evidence level of high 1
The American College of Physicians recommends targeting SpO2 ≥95% but monitoring respiratory rate and effort closely, with a strength of evidence level of high 1

The National Comprehensive Cancer Network recommends avoiding drugs that cause histamine release, such as morphine, atracurium, and mivacurium, as they may trigger vasospasm, with a strength of evidence level of moderate 2
The American College of Physicians recommends not discharging patients to the regular ward, as they require extended monitoring even after seemingly uncomplicated procedures, with a strength of evidence level of high 1