successful awake fiberoptic intubation and ultrasound guided epidural placement in anaesthesia management of a case of ankylosing spondylitis

Ankylosing spondylitis (as) is a chronic autoimmune spondyloarthropathy involving spine and sacroiliac joints resulting in characteristic bamboo spine (fused and rigid spine). a 41yr old male patient with ankylosing spondylitis with history of left thr presented with periprosthetic fracture posted for orif with plating. he had a classical bamboo spine with cervical involvement, mpc- 3 and restricted neck mobility. preoperative ultrasound scan (usg) of lumbar region done to identify spinal spaces. awake fiberoptic nasal intubation done to secure difficult airway and induction done with propofol and vecuronium. epidural catheter inserted at l1-l2 space using paramedian approach under usg under general anesthesia in lateral position and epidural analgesia given with 1% ropivacaine. extubation was done uneventfully with sugammadex 2mg/kg used as reversal at end of surgery. anaesthetic challenges in as were both difficult airway and difficult regional anesthesia which was successfully managed with detailed evaluation and planning with usg.