Rheumatoid arthritis of the cricoarytenoid joints: an airway hazard

The anesthesiologist must maintain a high index of suspicion for the presence of cricoarytenoid arthritis and vocal-cord fixation in the rheumatoid arthritic. He must be prepared to intubate the trachea blindly, attempting to minimize trauma by using a smaller endotracheal tube. Indirect laryngoscopy, or direct laryngoscopy using a fiberoptic laryngoscope, may be indicated as part of the preanesthetic evaluation. In some instances, preanesthetic tracheostomy or an alternative regional anesthetic technic may be appropriate. Unusually close vigilance in the postoperative period may be required to detect signs of postextubation airway obstruction.