TY  - JOUR
AU  - Ankit Arora
AU  - Girish Rawat
AU  - Harish Singh Koshiyari
TI  - Airway and positioning challenges in a patient with ankylosing spondylitis undergoing cholecystectomy: Role of intubating laryngeal mask airway and fiberoptic guidance
JO  - Journal of Scientific Innovations in Anesthesiology
PY  - 2026
VL  - 1
IS  - 2
SP  - 54
EP  - 59
DO  - 10.65929/JSIA.2026.1.2.005
SN  - 3139-3608
AB  - Ankylosing spondylitis (AS) produces progressive spinal rigidity, fixed deformity and restrictive lung disease, posing major challenges for airway management, positioning and ventilation. We report the anesthetic management of a 49‑year‑old man with severe AS, fixed cervicothoracic kyphosis, restrictive lung physiology and chronic voice change who presented for cholecystectomy. He could not lie supine and tolerated only a modified Fowler’s position. Anticipating a difficult airway and poor pulmonary reserve, an awake fiberoptic intubation was kept as backup, but we elected to perform asleep intubation through an intubating laryngeal mask airway (I‑LMA) because the patient was extremely anxious and unable to cooperate for a prolonged awake procedure in his compromised position. After meticulous padding and positioning, induction was achieved with titrated propofol and fentanyl while maintaining spontaneous breathing. An I‑LMA was inserted without neck movement, ventilation confirmed, and rocuronium administered. A 7.5‑mm endotracheal tube was then railroaded over a flexible fiberscope through the I‑LMA, which was subsequently removed. Laparoscopic cholecystectomy had to be converted to open surgery because pneumoperitoneum and instrument mobility were limited in the extreme semi‑recumbent posture. The intra‑operative and postoperative courses were uneventful; neuromuscular blockade was reversed with sugammadex and analgesia provided with multimodal opioids and non‑opioid agents. This case highlights the importance of individualized airway planning, careful positioning and the usefulness of I‑LMA–assisted fiberoptic intubation in AS patients with combined airway and positioning challenges. Keywords: Ankylosing spondylitis, Difficult airway, Intubating laryngeal mask airway, Fiberoptic intubation, Laparoscopic cholecystectomy, Restrictive lung disease.
UR  - https://jsiajournal.org/volume/1/issue/2/article/airway-and-positioning-challenges-in-a-patient-with-ankylosing-spondylitis-undergoing-cholecystectomy-role-of-intubatin
ER  -