Anesthesia in systemic lupus erythematosus: a review of key considerations and surgical challenges.

Systemic Lupus Erythematosus (SLE) presents complex challenges in the perioperative setting due to its multisystem involvement, immune-mediated pathology, and heterogeneous presentation. This narrative review explores the pathogenesis of SLE and its surgical implications, emphasizing how immune dysregulation, vascular endothelial dysfunction, and immunosuppressive therapy influence anesthetic management. It discusses the importance of comprehensive preoperative assessment, focusing on cardiovascular, pulmonary, renal, neurological, and hematological systems, to guide individualized anesthetic planning. Special attention is given to pharmacotherapy management, perioperative monitoring, and strategies to prevent disease flares. The role of spinal, epidural, and general anesthesia in surgical procedures and obstetric care for SLE patients is analyzed, highlighting benefits, risks, and precautions. By synthesizing multidisciplinary strategies and tailoring anesthetic approaches to SLE's variability, this review provides a framework to guide clinicians in optimizing perioperative safety for SLE patients. Future research should focus on standardized protocols and novel monitoring technologies to enhance outcomes.