Difficult Airway Management in an Ankylosing Spondilitis Patient

Introduction: Patients with severe ankylosing spondilitis (AS) are frequently difficult or impossible to intubate because of limited mouth opening and/or head extension. Case: A 40 year old man, ASA III status, with AS, that was planned to receive anesthesia for an elective posterior segmental instrumentation was considered as a difficult airway management. In the operating theatre, after taking all precautions, the position for Glidescope use (GS) was given like the patients feet, knees, shoulders and head were supported on pillows and then the table was adjusted to a moderate head-down position to give neutral position as far as possible within his comfort range and general anesthesia was induced. The laryngeal view was considered as Grade I (Cormack Lehane) with direct laryngoscopy. The intubation process succeeded smoothly at the first attempt. The operation was ended without any complication. Discussion: Although awake fibreoptic intubation is the best choice, the other options such as lariyngeal mask airway, GS or direct laryngoscopy may be used for AS patients for airway management especially when they refuse to be intubated awake. These options are chosen according to the patients and clinicians preferences, type of the procedure and the clinicians experience. Result: As a conclusion our case highlights that, direct laryngoscopy in the GS position might be a good, practical and useful option for AS patients.