Anesthesia Considerations 

Systemic Lupus Erythematosus (SLE)

 

 

Considerations 

 

• Potential difficult airway but usually NOT an issue:

  • C-spine arthritis

  • Cricoarytenoid arthritis

  • Recurrent laryngeal nerve palsy

• Multisystem complications of SLE:

  • CNS: central & peripheral sensorimotor & autonomic neuropathies, seizure, stroke, mood, confusion, organic disease, transverse myelitis

  • Cardiovascular: pancarditis with myocarditis (conduction disease, CHF), pericarditis (effusions/tamponade), non-infectious endocarditis (aortic & mitral regurgitations), accelerated coronary disease, hypertension, pulmonary hypertension 

  • Pulmonary: restrictive lung disease (ILD, pleuritis, effusions), pulmonary hypertension/RV failure, infection, pulmonary hemorrhage

  • Renal: lupus nephritis, CRF

  • Hematology: antiphospholipid-Ab syndrome common, risk of thromboembolism, anemia, thrombocytopenia, leukopenia factor deficiency (VIII, IX, XII) with implications for regional anesthesia 

  • Liver dysfunction can occur 

  • MSK: vasculitis, arthritis, joint immobility, migratory polyarthritis

• Medications:

  • Steroids (Cushings/hyperglycemia/adrenal suppression/need for stress dose)

  • Immunosuppresants/antimalarials

  • NSAIDs

  • Anticoagulants/ASA

• Potential for acute exacerbation with surgery, stress, infection & pregnancy

• Obstetric & cardiac anesthesia, especially in those with aPL antibodies or APS, requires multidisciplinary management at a specialist center

 

 

Pregnancy Considerations 

 

• ↑ risk of preterm labour & intrauterine fetal death

• Multidisciplinary management: rheumatology, obstetrics, anesthesia 

• Potential coagulopathy may contraindicate use of neuraxial → ensure early hematology consult 

  • ↑ PTT can have 2 causes: 

    • Presence of lupus anticoagulant: just a lab abN so clinically ok for neuraxial, these patients can actually be hyper-coagulable 

    • Autoantibodies against specific coagulation factors (e.g., VIII, IX, XII): risk of true coagulopathy → neuraxial contraindicated  

• Document any pre-existing central or peripheral sensorimotor & autonomic neuropathies prior to regional technniques

• Potential for neonatal lupus & congenital heart block