Med. praxi. 2010;7(3):125-129

Preoperative and perioperative care in patient with rheumatic disease

MUDr.Martina Skácelová¹, doc.MUDr.Pavel Horák, CSc.¹, doc.MUDr.Jiří Gallo, Ph.D.², MUDr.Andrea Smržová¹

¹ III. interní klinika FN a LF UP Olomouc

² Ortopedická klinika FN a LF UP Olomouc

Preoperative care and evaluation of surgery risk in patients with rheumatic diseases is coordinated by rheumatologist. Preoperative

evaluation includes history, physical and laboratory examination for evaluation of cardiovascular, renal, peripheral vascular and anestesia

risk for patient. In patients with rheumatoid arthritis it is important to evaluate the cervical spine involvement. The administration

of drugs before and after surgery can interfere with operation risk. It is recommended to administer i. v. 100 mg of hydrocortisone,

and repeat the dose after 8 hours if necessary or to administer continuous peroperative hydrocortison 10 mg/h i. v. NSAIDs should be

discontinued at least 3 half-live periodes before the scheduled surgery, acetylsalicylic acid as an permanent inhibitor of platelet COX

-1 at least 7 days before surgery. Methotrexate needs not be withdrawn, with the exception of older patients, patients with renal insufficiency,

with poorly controlled diabetes, diseases of the lungs and liver. Drugs causing leucopenia are recommended to discontinue

for several days before surgery. It is recommended to discontinue leflunomide 2 weeks before elective surgery. Antimalaric drugs have

long tissue half- time, it is not effective to withdraw them. It is recommended not to administer TNF alpha blockers a week or two prior

surgery and to return to the therapy after the operation wound healing.

Keywords: preoperative care, surgery, rheumatoid arthritis, corticosteroids, NSAIDs, DMARDs, biological therapy

Published: May 1, 2010  Show citation