Laryngeal mask airway in severe cervical ankylosis

Abstract

We present a case of the successful use of a laryngeal airway (LMA) to ventilate the lungs of a patient with severe ankylosing spondylitis for surgery requiring intense muscular relaxation. The use of an LMA in such circumstances is controversial. The patient was a 61-yr-old man with severe emphysema, a cervical spine fixed in marked anterior flexion, and reduced mouth opening (35 mm). The patient refused an awake tracheal intubation because of a previous distressing experience with a fibreoptic awake nasal intubation and an 11 day SICU stay with controlled ventilation via an endotracheal tube. Attempts at spinal blocks had failed in the past. After administration of thiopentone and succinylcholine a #4 LMA was inserted and the lungs were safely ventilated for a 10 min reduction of a dislocated femoral head. The present view that severe ankylosing spondylitis is a contraindication to the use of an LMA may need revision in view of this and other reports of successful airway management in patients with that disease.