How Does RP Affect Anesthesia and Intubation Planning?

Relapsing polychondritis (RP) can weaken or destroy the cartilage that holds your windpipe (trachea), voice box (larynx), and the tubes leading to your lungs (bronchi) open ^[1]. Because of this, RP can create an unexpectedly difficult or collapsible airway ^[1]. It is important to know that RP severity varies, and having the disease does not automatically mean you will have a difficult intubation or require intensive care. However, even if you are having a minor surgery that has nothing to do with your RP, the anesthesiologist must know about your condition to properly assess your individual risk ^[2].

Standard anesthesia medications relax your muscles, and if your airway cartilage is damaged, your airway can physically collapse once you are sedated ^[1][2]. Because an unrecognized difficult airway can be life-threatening, it is vital to share your complete medical history and collaborate with your medical team to create a comprehensive airway plan before any procedure involving sedation or anesthesia ^[2][3].

Preoperative Assessment and Airway Evaluation

Your anesthesiologist should evaluate your respiratory health well before your surgery date. Because airway damage can be “silent”—present even when you have no noticeable symptoms—your team cannot rely on how you feel alone ^[4][5]. Depending on your history and the planned surgery, your team may request or review:

• A review of your symptoms: Be sure to mention any hoarseness, wheezing, shortness of breath, a high-pitched breathing sound (stridor), or breathing difficulties that wake you up at night ^[6].
• Prior airway imaging: The team may review recent chest or neck CT scans. If airway collapse is suspected, inspiratory and dynamic expiratory CT scans (images taken as you breathe in and out) may be ordered to see if the windpipe collapses under pressure ^[5].
• Pulmonary function tests (PFTs): Tests that measure your lung capacity—such as your forced vital capacity (FVC) and the shape of your flow-volume loop—can help identify blockages in your central airway ^[7][8].
• Previous anesthesia records: If a doctor has ever told you that you have a “difficult airway,” or if you have had a breathing tube placed with difficulty in the past, this is critical information ^[2].
• Use of airway devices: Inform them if you use a CPAP or BiPAP machine at home to support your breathing ^[9].
• Current disease activity: Let the team know if you are currently experiencing an RP flare, as active airway inflammation increases surgical risks ^[10].

Building a Risk-Based Airway Plan

You should request a specific difficult-airway plan tailored to your anatomy ^[3]. Depending on your risk, this plan may include:

• Experienced personnel and location: Your anesthesia should be managed by a clinician highly experienced with difficult airways ^[3]. If you have known, severe airway disease, your care might need to be transferred to a specialized tertiary center, and an ear, nose, and throat (ENT) specialist or surgeon may need to be available as backup ^[3][8].
• Protecting spontaneous breathing: If significant collapse is suspected, the anesthesiologist might choose an “awake intubation” using numbing medicine, or use other techniques that allow you to keep breathing on your own until the breathing tube is safely secured ^[11].
• Specialized equipment: The team may prepare alternative tools, such as a video laryngoscope (a camera-equipped instrument used to guide the breathing tube) or a flexible bronchoscope ^[12].
• Emergency rescue options: For highly selected patients with severe disease, the team must have a surgical backup plan (such as a tracheostomy) ^[2]. In extraordinarily rare cases at specialized centers, extracorporeal membrane oxygenation (ECMO)—a machine that bypasses the lungs—may be planned as a rescue measure ^[11].
• Postoperative monitoring: Waking up and removing the breathing tube (extubation) requires a careful plan ^[2]. Based on your risk, you may require fully awake extubation, close monitoring in an Intensive Care Unit (ICU), or the supervised use of non-invasive ventilation like CPAP or BiPAP ^[2][9].

Systemic Issues the Team Must Know

RP affects more than just your airway. Your anesthesiologist must also coordinate with your rheumatologist regarding:

• Heart and aortic involvement: RP can cause silent widening of the aorta, leaky heart valves, or electrical conduction issues ^[13]. Based on your symptoms and history, your team may order an echocardiogram or electrocardiogram (ECG) to assess your cardiovascular risk before surgery ^[14].
• Eye inflammation: If you have active eye inflammation, such as scleritis or uveitis, the team must be extra cautious to protect your eyes from pressure or dryness while you are asleep ^[15].
• Immunosuppressive medications: Provide an exact list of your medications and doses. Do not stop taking corticosteroids (like prednisone), biologics, or other immunosuppressants on your own. Stopping them abruptly can trigger a severe disease flare or a dangerous drop in blood pressure (adrenal crisis) ^[16]. Your surgical and rheumatology teams must decide together which medications to hold or continue, whether you need a “stress dose” of IV steroids during surgery ^[16], and how to manage the increased risk of postoperative infections ^[17][18].