A review of the implications of rheumatoid arthritis on peri-operative anaesthetic management is presented. Pre-operative assessment should include a careful search for articular and systemic manifestations of the disease that may complicate intraoperative care. Drug disposition may vary from the normal patient as a result of changes in serum protein binding, together with possible exaggeration of pharmacodynamic responses. Airway management presents one of the greatest challenges to the anaesthetist, and care in manipulation of the cervical spine is paramount.
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