Reduce Stressors – Attempt to alleviate stressors.

Avoid Hypothermia – Protect the hands and feet from cold. Prophylactically warm the patient. Raise the temperature of the OR and make efforts to maintain normothermia.

Arterial Lines – If possible, it is strongly suggested to avoid radial arterial lines that may trigger the vasospastic response.

Dopamine – identified as the culprit for multiple cases of Raynaud’s. Be especially vigilant in cases where the dopamine is being infused through a peripheral line.

SaO2 monitoring – Vasospasm may make it difficult to obtain pulse oximetry readings.

Local anesthetics – Avoid epinephrine in local anesthetic solutions.

Continue antihypertensive medications – antihypertensive agents such as calcium channel blockers or a-blockade agents are used to treat this condition and should be continued into the perioperative period.

Pain – Anecdotal sympathetic blockade has been used to treat ischemic pain associated with Raynaud’s.

Classified as a peripheral arterial disease. Primary Raynaud’s (Reynaud disease) is not associated with other diseases while Secondary Raynaud’s (Reynaud phenomenon) is associated with another condition.

Characterized by vasospasm of smaller arteries which causes ischemia, manifesting as blanching or cyanosis of primarily the digits of the hands and feet. This may also occur in the ears or tip of the nose.

The increased sympathetic activity seen in Raynaud’s can last for up to 2 days.

Sequence of discoloration is usually pallor to cyanosis to rubor.

This condition is typically triggered by cold or stress, but may also be induced by smoking, use of vibrating tools or pharmaceuticals such as B-adrenergic agonists, tricyclic antidepressants, amphetamines, etc.

Because this condition is so often associated with other conditions, diagnosis is often followed by more clinical queries to investigate any other underlying problems. This condition is classified as secondary when associated with conditions such as connective tissue diseases (RA, SLE, dermatomyositis, scleroderma), trauma, neurologic syndromes (carpal tunnel, cerebrovascular accident, intervertebral disk herniation), or peripheral arterial occlusive disease (atherosclerosis).

Raynaud’s is often distinguishable from other conditions as there will be a clear side-by-side demarcation of color between the affected and unaffected skin.

Prevalence is 95% of patients with systemic sclerosis, 20-30% of patients with Sjogren disease or SLE, and less than 5% of patients with Rheumatoid Arthritis.

Affects primarily women