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CASE REPORT
Year : 2020  |  Volume : 3  |  Issue : 1  |  Page : 35-38

Airway management in a ‘rigid man’ with severe ankylosing spondylitis


Department of Anesthesiology, PD Hinduja Hospital and Medical Research Centre, Mumbai, Maharashtra, India

Correspondence Address:
Dr. Joseph N Monteiro
Department of Anesthesiology, PD Hinduja Hospital and Medical Research Centre, Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ARWY.ARWY_32_19

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Fibreoptic-guided intubation is the gold standard in managing both the anticipated and unanticipated difficult airway. We report a 34-year-old male, a case of severe ankylosing spondylitis for 10 years which was progressive in nature, posted for elective left-sided hip replacement followed a week later by right-sided hip replacement. The patient had a fixed spine with absent lumbar and thoracic curvatures and had a mouth opening of <1 cm. The neck was fixed in flexion and rotated slightly towards the right as a result of the deformity. Our plan of anaesthetic management was to secure the airway by awake nasal intubation using fibreoptic bronchoscope followed by general anaesthesia. The ultimate challenge was to secure the airway using the fibreoptic bronchoscope in this patient with a flexed and stiff neck. We successfully managed this case using a Portex® north-polar tube placed nasotracheally in the awake state following topical anaesthesia. Based on our experience, we believe that such a procedure should be considered in other similar situations.


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