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MEDICAL CONDITIONS OF ANAESTHETIC INTEREST
Of anaesthetic interest:
• Rheumatoid arthritis
• Muscular dystrophy and myotonic conditions
• Multiple sclerosis
• Chronic liver disease
• Kidney failure
• Morbid obesity
• Parkinson's disease
By way of example, below are some of the anaesthetic problems related to the presence of Rheumatoid Arthritis
Autoimmune disease of unknown cause characterised primarily by a chronic inflammatory condition with severe and progressive articular affection, together with significant systemic implications.
From the anaesthetic standpoint, the following manifestations should be taken into account:
1-Articular affection. Deformity, instability and/or reduction in the mobility of the cervical spine or temporomandibular joint can considerably hamper orotracheal intubation operations.
In the event of major cervical instability, the presence of neurological compromise should be ruled out before the operation; in some patients it may even be necessary to stabilise the cervical spine first.
Inflammation of the cricoarytenoid joint (pain on swallowing, hoarseness, stridor) may give rise to a glottal stricture that will hamper orotracheal intubation and lead to post-extubation (removal of the orotracheal intubation tube) laryngeal obstruction.
2. Systemic affection. The systemic symptoms to be assessed are the presence of pericardial effusion, coronary arteritis or myocarditis, mitral or aortic valve disease, pleural effusion and interstitial lung disease, peripheral neuropathies, kidney or liver impairment and keratoconjunctivitis sicca (inability to produce tears). The existence of signs and symptoms such as dyspnoea, fatigue, heart murmurs, persistent cough and expectoration, altered chest x-ray, numbness or the sensation of rubbing while blinking suggest a major systemic impact. The presence of some of these systemic symptoms may require pre-op action (pleural or pericardial effusion), condition the type of anaesthesia to be used (coronary arteritis or myocarditis) and/or the choice of anaesthetic drugs (kidney or liver impairment).
3 Prescribed treatment. The use of acetylsalicylic acid or other anti-inflammatory agents can increase surgical bleeding and prevent the performance of regional anaesthetic techniques. Therefore, ASA should be discontinued 7 to 10 days before the operation.
In case of chronic treatment with corticosteroids, the patient should be supplemented with intramuscular or intravenous corticoids prior to surgery.
If you have any of the above conditions, inform the surgeon and the anaesthesiologist and also inform them of any other treatments you are taking before the surgery.
In any event, it is fundamental that the disease be under control and be stable before the surgery. Therefore, if you have regular examinations, analyses and/or tests to assess your disease's evolution, you should provide the the Anaesthesiology Department latest results (less than 1 month). For example, if you have a thyroid disorder (hyper- or hypothyroidism), you should produce recent thyroid functionalism (TSH, T3, T4) tests before surgery.