The Surgical Treatment of Rheumatoid Arthritis

[Guest guest]

Hospital for Special Surgery

January 31, 2001

Nestor, MD

Assistant Professor of Orthopaedic Surgery, Weill Medical College of

Cornell University, Assistant Attending Orthopaedic Surgeon, Hospital

for Special Surgery

An excerpt from a Q & A entitled, " The Surgical Treatment of Rheumatoid

Arthritis " :

" Dr. Fields: From a rheumatologist's point of view, we spend a lot of

time preoperatively evaluating patients as to whether they may have an

unstable cervical spine. How is that a problem for the Orthopaedic and

anesthesia management of the patient?

Dr. Nestor: What is important to recognize is that cervical spine

involvement 30 to 40 percent of patients will have some type of

involvement, and half the time it may be asymptomatic. Therefore, it is

important to always consider in the patient careful neurological

examination and appropriate radiographs when indicated. The impact it

has on the surgical care, if there is significant stability present or

neurological change, then the patient even require a operation for

stabilization before considering other reconstructive procedures. More

commonly, it just simply requires care in the operating room. Regional

anesthesia is preferred over a general anesthesia. If there is concern

about airway management, we think that intubation will be necessary,

then generally, that is done under a very controlled environment, with

the patient sedated, and using fiberoptic intubation. "

http://rheumatology.hss.edu/phys/interviews/nestor_int_tran.asp

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org