ANTICIPATED DIFFICULT AIRWAY MANAGEMENT IN A KNOWN CASE OF ANKYLOSING SPONDYLITIS WITH KYPHOTIC DEFORMITY

Abstract

Ankylosing Spondylitis is chronic inammatory disease involving mainly sacroiliac joint progressing centrally to vertebrae leading to brosis and fusion. Due to brosis of cervical spine and temperomandibular joint, patient has decrease cervical spine mobility and limited mouth opening. The rigid spine makes positioning very difcult adding difculty to airway process. We report a 32year old male, a case of ankylosing spondylitis for 4 years which was progressive in nature with involvement of all the facet joints of spine resulting in thoracolumbar kyphosis, posted for deformity correction and posterior instrumentation. Due to kyphotic deformity and cervical spine brosis, patient had inability to lie down supine, restricted neck movements of exion, extension and lateral rotation with mouth opening of <1cm.Plan of anaesthetic management was to secure the airway by awake nasal intubation using Ambu a Scope bronchoscope followed by general anaesthesia. The ultimate challenge was to secure the airway in this patient with cervical exion deformity. We successfully managed this case by giving RAMP position and nasotracheal intubation with exometallic tube in awake state using Ambu a Scope bronchoscope with necessity to apply external laryngeal pressure for optimized glottis exposure following topical anaesthesia and sedation with dexmedetomidine. Awake breoptic intubation is the safest option in these patients with potentially difcult airway as it allows continuous monitoring and preserves spontaneous respiration until a denitive airway is established