Sjogren's Syndrome & General Anesthesia

Sjogren's syndrome is an autoimmune condition, which means that the immune system develops an anomaly in which immune cells attack the body's own natural cells. It generally occurs in women in their late 40s and can cause destruction of various exocrine glands, such as those responsible for tears and for saliva. Unlike many auto-immune diseases, there are no instances of it going into remission, and there is no known cure. As a result, many treatments for Sjogren's focus on controlling the symptoms.

Sjogren's Symptoms

The symptoms of Sjogren's syndrome are caused by a lack of secretions from certain glands. The primary symptoms are dryness of the eyes and mouth, which is caused by a lack of activity from the lacrimal glands (responsible for tears) and salivary glands, respectively. Other symptoms include dryness of the nose, vagina and skin.

Medications to Avoid

Because of the symptoms of Sjogren's syndrome, certain medications are to be avoided during general anesthesia. These include any anti-cholinergic medications, because these medications will only make the symptoms worse. Examples of these anesthetics with anti-cholinergic effects include atropine, glycopyrrolate and diphenhydramine.

General Anesthesia and Steroids

In extreme cases, patients who suffer from Sjogren's syndrome may take corticosteroids as part of their treatment. This is done because these steroids will suppress the immune system, which will then reduce the effects of this auto-immune disease. Because the effects of corticosteroids are affected by stress, and because general anesthesia (and the ensuing surgery) causes stress to the body, patients who are taking corticosteroids will need to take a "stress" dosage of their medications (generally less than their normal dose) before receiving general anesthesia.

Operating and Recovery Room Conditions

To prevent the mouth and eyes from drying out during general anesthesia, certain precautions must be taken. The temperature in the operating room will need to be increased, because patients with Sjogren's symptom are prone to Raynaud's phenomenon, in which circulation to the fingers is reduced. The patient will also need a humidifier placed in the room, and the nurse should carefully lubricate and use extra care when placing an endotracheal tube. The patient will also need to be kept well hydrated while recovering, as well as having enough artificial tears to keep the eyes from drying out during recovery.

Considerations During Surgery

Another aspect of Sjogren's syndrome that must be considered is the fibromyalgia (muscle pain) and arthritis that often accompany the syndrome. This, combined with the general anesthesia, can make moving and positioning the patient very difficult, as the joints may be unusually rigid. As a result, patient movement and positioning will need to be coordinated with the entire operating team, both to help the surgeons and to avoid disturbing the patient, possibly causing him to "wake up" from the anesthesia.