Juvenile Rheumatoid Arthritis

Children with juvenile rheumatoid arthritis tend to develop fusion of the cervical spine and premature closure of epiphyseal plates, leading to hypoplastic mandible and fixed neck. Oral intubation of the trachea in this setting is essentially impossible. Regional anesthesia can also be complicated in this group because of a characteristic lumbar lordosis and an inability to abduct the shoulder. These factors make lumbar epidural and axillary blocks technically more difficult. Central venous lines may also be difficult to insert because an inability of the child to rotate the head is combined with the forward flexion of the neck.^[273]