Anesthetic management of a scleroderma patient undergoing tricuspid valve replacement under cardiopulmonary bypass

Scleroderma is a multisystem disease that starts with the inflammation and atrophy of small blood vessels and leads to fibrosis of the skin and visceral organs. The pathological effects of the disease on various organ systems significantly impact aspects of anesthetic management. In this article, we describe the general anesthetic management of a scleroderma patient undergoing tricuspid valve replacement under cardiopulmonary bypass. We also review for the anesthesiologist perioperative considerations particular to this disease, especially the selection of anesthetic type, method of tracheal intubation, and establishment of venous access. The management of pulmonary hypertension and other anesthesia-related complications during the perioperative period are also discussed.