Anaesthetic management of ankylosing spondylitis with global kyphosis undergoing spine correction using awake fiberoptic intubation

Kumar SV, Jayaraman V, Ramasamy AM

Pdf Page Numbers :- 440-443

Varun Kumar S^1,*, Jayaraman V¹ and Arul Murugan Ramasamy¹

¹Department of Anaesthesiology and Pain Medicine, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai - 600116, Tamil Nadu, India

*Corresponding author: Dr. Varun Kumar. S, Department of Anaesthesiology and Pain Medicine, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai - 600116, Tamil Nadu, India. Email: varun27395@gmail.com

Received 18 August 2025; Revised 1 October 2025; Accepted 9 October 2025; Published 15 October 2025

Citation: Kumar SV, Jayaraman V, Ramasamy AM. Anaesthetic management of ankylosing spondylitis with global kyphosis undergoing spine correction using awake fiberoptic intubation. J Med Sci Res. 2025; 13(4):440-443. DOI: http://dx.doi.org/10.17727/JMSR.2025/13-77

Copyright: © 2025 Kumar SV et al. Published by KIMS Foundation and Research Center. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Abstract

Ankylosing spondylitis (AS) with severe global kyphotic deformity poses major anaesthetic challenges, particularly with airway management and intraoperative positioning. We describe the perioperative anaesthetic management of a 43-year-old female with advanced AS and a fixed global kyphotic posture undergoing corrective spinal deformity surgery. The patient exhibited markedly restricted cervical mobility, a fixed flexion deformity of the entire spine, and compromised pulmonary function. Anticipating a difficult airway, awake fibreoptic nasal intubation was performed under meticulous airway topicalisation and titrated conscious sedation. Following successful intubation, general anaesthesia was induced and the patient was positioned in a modified prone posture with careful padding and continuous haemodynamic monitoring. The seven-hour procedure was associated with an estimated blood loss of approximately 2000 mL, managed with transfusion of four units of packed red blood cells, four units of fresh frozen plasma, and one unit of platelets. Postoperatively, the patient was electively ventilated in the ICU and extubated 12 hours later without complications. This case underscores the importance of thorough preoperative preparation, patient cooperation, and expert airway management in individuals with severe spinal deformity. Awake fibreoptic intubation remains the gold standard in anticipated difficult airways, particularly in AS with limited cervical and thoracic spine mobility. Multidisciplinary coordination and vigilant perioperative care are crucial for achieving favourable outcomes in such complex cases.

Keywords: ankylosing spondylitis; difficult airway; global kyphosis; awake fibreoptic intubation; spine deformity correction