Anesthetic Challenges in a Patient with Ankylosing Spondylitis Undergoing Corrective Spinal Surgery: A Case Report
Abstract
Ankylosing spondylitis (AS) is a progressive inflammatory disease characterized by spinal rigidity, kyphotic deformities, and significant challenges in airway management during surgery. We report the case of a 50-year-old male with severe kyphosis caused by long-standing AS, scheduled for corrective spinal surgery. Preoperative assessment revealed restricted cervical mobility, a “chin-on-chest” deformity, and a high risk of
difficult intubation. Awake video-laryngoscopy-assisted intubation, combined with regional airway blocks, was successfully performed to minimize complications. Intraoperative neuromonitoring, strategic positioning, and meticulous hemodynamic management were implemented to ensure patient safety. The surgery was completedwithout neurological deficits, and the patient was discharged in stable condition. This case underscores the importance of thorough airway planning, neuromonitoring, and intraoperative vigilance in AS patients undergoing spinal correction. It highlights the critical role of a multidisciplinary approach in achieving successful surgical outcomes.
management. F1000Res. 2018;7:F1000 Faculty Rev-1512. https://doi.org/10.12688/f1000research.14956.1.
[2] Copuroglu E, Sagiroglu G. Is regional anesthesia a safe technique for patients with severe ankylosing spondylitis undergoing total hip replacement surgery? Int J Surg. 2018;5(8):2913- 6. https://doi.org/10.18203/2349- 902.isj20183214.
[3] Woodward LJ, Kam PC. Ankylosing spondylitis: recent developments and anaesthetic implications. Anaesthesia. 2009;64(5):540-8. https://doi.org/10.1111/j.1365-2044.2008.05794.x.
[4] Schelew BL, Vaghadia H. Ankylosing spondylitis and neuraxial anaesthesia - a 10 year review. Can J Anaesth. 1996;43(1):65- 8. https://doi.org/10.1007/BF03015960.
[5] Hoh DJ, Khoueir P, Wang MY. Management of cervical deformity in ankylosing spondylitis. Neurosurg Focus. 2008;24(1):E9. https://doi.org/10.3171/FOC/2008/24/1/E9.
[6] Sciubba DM, Nelson C, Hsieh P, Gokaslan ZL, Ondra S, Bydon A. Perioperative challenges in the surgical management of ankylosing spondylitis. Neurosurg Focus. 2008;24(1):E10. https://doi. org/10.3171/FOC/2008/24/1/E10.
[7] Kotekar N, Nagalakshmi NV, Rehman M. A case of severe ankylosing spondylitis posted for hip replacement
surgery. Indian J Anaesth. 2007;51(6):546-9.
[8] Ul Haq MI, Shamim F, Lal S, Shafiq F. Airway management in a patient with severe ankylosing spondylitis causing bamboo spine: use of Aintree intubation catheter. JCPSP. 2015;25(12):900-2.
[9] Kolb B, Large J, Smurthwaite G. An innovative system to facilitate extension osteotomy in the prone position for
chin-on-chest deformity of ankylosing spondylitis. Int J Spine Surg. 2020;14(6):1009-15. https://doi.org/10.14444/7151.
[10] Langeloo DD, Journee HL, Pavlov PW, de Kleuver M. Cervical osteotomy in ankylosing spondylitis: evaluation of new
developments. Eur Spine J. 2006;15(4):493-500. https://doi.org/10.1007/s00586-005-0945-z.
[11] Penney R. Use of dexmedetomidine and ketamine infusions during scoliosis repair surgery with somatosensory and
motor-evoked potential monitoring: a case report. AANA J. 2010;78(6):446-50.
[12] Andleeb R, Agrawal S, Gupta P. Evaluation of the effect of continuous infusion of dexmedetomidine or a subanesthetic dose ketamine on transcranial electrical motor evoked potentials in adult patients undergoing elective spine surgery under total intravenous anesthesia: a randomized controlled exploratory study. Asian Spine J. 2022;16(2):221-30. https://doi.org/10.31616/asj
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Issue | Vol 9 No 5 (2024): September -October | |
Section | Case Report(s) | |
Keywords | ||
Anesthetic challenge Ankylosing spondylitis Neuromonitoring |
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