Sarcoidosis
Background
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Sarcoidosis is a multisystem granulomatous disorder of unknown etiology that is characterized by presence of noncaseating granulomas in involved organs. It initially presents with one or more of the following abnormalities:
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Bilateral hilar adenopathy
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Pulmonary reticular opacities
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Skin, joint, and/or eye lesions
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Considerations
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Potential difficult airway (laryngeal/tracheal granulomatous disease. nasal mucosal sarcoidosis)
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Multisystem granulamotous disease:
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Pulmonary
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A/W Tree: Endobroncial sarcoid, laryngeal sarcoidosis/stenosis
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Pulmonary fibrosis, pHTN and cor-pulmonale, ↓ DLCO
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CVS:
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Conduction defects, CHF, restrictive CM, MR from pap muscle involvement, systolic/diastolic function
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CNS: central DI (granulomas), dementia, encephalopathy, seizures, polyneuropathy
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GI: Hepatomegaly & liver dysfunciton
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Metabolic derrangement: Hypercalcemia
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Medications: maybe on steroid Rx → stress dose
Goals
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Anticipate potential difficult airway
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Manage potential cardiomyopathy/AICD
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Appropriate ventilatory strategy for restrictive lung disease and pulmonary fibrosis
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Avoid exacerbation of cor pulmonale and pulmonary hypertension
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Consider stress dose steroids
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Anticipate complications: prolonged NMB, hypercalcemia, arrhythmias, etc
References
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Sarcoidosis and anaesthesia. BJA Education, Volume 16, Issue 5, May 2016, Pages 173–177