Raynaud Syndrome

At a glance

Short duration vasospasms of the small arteries of the arms and legs, hands and feet leading to numb and white digits. Usually diagnosed before age 40 years. Distinguish between Raynaud’s Disease (familial) and Raynaud’s Syndrome (acquired).

Synonyms

Raynaud Disease; Raynaud Phenomenon; Acrocyanosis Chronica Anesthetica; Symmetric Asphyxia.

Classification

There are two different types for this medical condition:

• Raynaud Disease: Refers to the familial (genetic transmission) medical condition.

• Raynaud Syndrome/Phenomenon: Refers to the acquired symptoms observed with Raynaud Disease. However, this clinical condition is often caused by an underlying disease and proper investigation must be conducted to establish the diagnosis. Disorders associated with Raynaud Syndrome include the following:

  • Neurovascular compression (thoracic outlet syndromes, crutch pressure carpal tunnel syndrome)

  • Arterial diseases (thromboangiitis obliterans, thromboembolism, arteriosclerosis)

  • Blood abnormalities (cryoglobulinemia, cryofibrinogenemia, cold hemagglutinins, monoclonal gammopathy, polycythemia)

  • Occupational (percussion and vibratory tool workers, traumatic occlusive arterial disease, vinyl chloride workers)

  • Drugs and toxins (ergot, methysergide, beta-blocker drugs, chemotherapy, epinephrine)

  • Connective-tissue diseases (systemic sclerosis, systemic lupus erythematosus, mixed connective-tissue disease, rheumatoid arthritis, dermatomyositis, polymyositis)

  • Miscellaneous (complex regional pain syndrome—reflex sympathetic dystrophy, hypothyroidism, pheochromocytoma, neoplasm, primary pulmonary hypertension, variant angina)

History

First described by A. G. Maurice Raynaud, French physician, in 1862.

Incidence

Not known because of the confusion between the acquired form and familial illness; however, reported to range from 0.06 to 30% in the general population. Primary disease may vary from 15 to 75% in this population. Male:female ratio is 1:5. Most common in young women and 60 to 90% of reported cases are idiopathic.

Genetic inheritance

No evidence of genetic inheritance.

Pathophysiology

Unknown.

Diagnosis

Clinically evocated by characteristic attack of distal vasospasm with whitening of the extremities.

Clinical aspects

Intermittent attacks of numb and white fingers. The classic description includes three phases. First, vasospasm leads to pallor of the fingers and toes. Usually bilateral and involves all fingers. Occasionally, it may involve ears and nose. Second, capillaries dilate after a few minutes, but the digital arteries still are in spasm. The fingers get blue and the numbness and pain appear. Finally, the vessels dilate with redness of the fingers with a feeling of warmth and itching and tingling. In long-standing cases, atrophy and resorption of the fingertips with or without painful areas of necrosis may appear. Treatment with topical nitrates appears to be effective treatment.

Precautions before anesthesia

Assess the presence and the severity of the underlying diseases.

Anesthetic considerations

Special attention to avoid cold exposure. Peripheral pulse oximetry may not ...