Airway management in cervical spine ankylosing spondylitis:
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Ankylosing spondylitis (AS) is characterized by progressive ossification of the spinal column with resultant stiffness. AS does not typically result in dysphagia as the syndesmophytes are marginal. Dysphagia in the elderly is more commonly associated with diffuse idiopathic skeletal hyperostosis (DISH). Both these conditions, DISH and AS can be associated with anticipated difficult airway. We report the perioperative course of a patient with long standing ankylosing spondylitis with severe dysphagia due to large anterior cervical syndesmophytes at the level of the epiglottis. He was scheduled to undergo anterior cervical decompression and the surgical approach possibly precluded an elective pre-operative tracheostomy. We performed a modified awake fibreoptic nasal intubation through a split nasopharyngeal airway while adequate oxygenation was ensured through a modified nasal trumpet inserted in the other nares. We discuss the role of nasal intubations and the use of both the modified nasopharyngeal airways we used to facilitate tracheal intubation. This modified nasal fibreoptic intubation technique could find the application in other patients with cervical spine abnormalities and in other anticipated difficult airways...

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