Difficult intubation with inability to give spinal anaesthesia in a case of ankylosing spondylitis undergoing B/L total knee replacement: A case report

Abstract

Ankylosing spondylitis with spinal column involvement renders the spinal column more rigid and introduces difficulty in airway management of the patient. Use of spinal anaesthesia also becomes difficult due to bamboo spine. Use of advanced fibre optic bronchoscopy to facilitate intubation to secure difficult airways is well known. But this technique can be challenging due to difficulty in attaining appropriate position for intubation due to rigid curvature of the ankylosed spinal column and due to anxiety of the patients in view of it being awake intubation. In this case report we present a successful atraumatic nasotracheal intubation under FOB guidance in a case of Ankylosing Spondylitis undergoing Bilateral Total Knee Replacement under mild sedation.