Difficult Airway Management in a Conscious Patient With Ankylosing Spondylitis: A Case Report

Ankylosing spondylitis (AS) is a chronic inflammatory disease that may cause cervical deformity and ankylosis, complicating airway management. The success rate of direct laryngoscopy in this population is low, and awake endotracheal intubation with minimal cervical manipulation is recommended. We report the case of a 65-year-old man with AS and complete loss of cervical mobility scheduled for laparoscopic cholecystectomy. Airway evaluation revealed Mallampati III, mouth opening >3 cm, sternomental distance of 10 cm, and severe restriction of cervical extension. Due to the unavailability of equipment for awake fibreoptic intubation (AFI), videolaryngoscopy under remifentanil sedation and topical lidocaine was chosen. Orotracheal intubation (C-MAC D-Blade) was successfully performed, followed by general anaesthesia without complications. The patient was safely extubated after the procedure. This case suggests awake videolaryngoscopy as an alternative for airway management in patients with AS when fibreoptic bronchoscopy is not feasible.