Endotracheal intubation of an awake patient with the diagnosis of Ankylosing Spondylitis

• Published in: Revista cubana de medicina militar Vol. 53; no. 3; p. e024056756
• Main Authors: Yudiel González Álvarez, Yissel Fernández Serrat, Isel Vera Díaz, Junior Vega Jiménez, Lisneybi Gonzalez Gonzalez
• Format: Journal Article
• Language: Spanish
• Published: ECIMED 01-09-2024
• Subjects: espondilitis anquilosante; intubación e inducción de secuencia rápida; manejo de la vía aérea
• ISSN: 1561-3046

Introduction: Ankylosing spondylitis is a disease that affects the axial skeleton with the participation of the sacroiliac joints and causes the progressive formation of intervertebral syndesmophytes. These patients are considered to have difficult airways. Objective: To present a patient with a diagnosis of Ankylosing Spondylitis and difficult airway, scheduled for bilateral total hip prosthetic replacement under general anesthesia. Clinical Case: 48-year-old male with ankylosing spondylitis, dilated cardiomyopathy, essential arterial hypertension, moderate chronic multifactorial anemia, who required scheduled surgical intervention for bilateral total hip replacement due to osteoarthrosis in both joints. With a III classification of the American Society of Anesthesiology, the procedure was performed in two surgical stages. For the anesthetic approach, endotracheal intubation was performed with the patient awake with prior psychological preparation. Local anesthetic (lidocaine) was used for pharyngeal micronebulization with a face mask, block of the superior laryngeal nerves, and transtracheal block for intubation with a flexible fiberoptic bronchoscope. Due to the risk of displacement of the prosthesis when changing position, the procedure was repeated three months later. Conclusions: Successful endotracheal intubation of an awake patient with a difficult airway is shown.