Difficult Airway Management in Patients with Ankylosing Spondylitis Undergoing General Anaesthesia

Background: Airway management in patients with ankylosing spondylitis (AS) is a major anesthetic challenge due to progressive cervical spine rigidity, limited neck extension, restricted mouth opening, and altered airway anatomy. These changes increase the risk of difficult intubation, failed airway management, and perioperative complications. Careful preoperative airway assessment and the use of advanced airway techniques are essential to ensure patient safety during general anesthesia. Case Presentation: We present a case series of five patients with ankylosing spondylitis who underwent various surgical procedures under general anesthesia and were identified preoperatively as having anticipated difficult airways. Airway management strategies were individualized according to the severity of cervical spine involvement and airway assessment findings. Awake fibreoptic intubation, videolaryngoscopy, intubating laryngeal mask airway assisted intubation, and fibreoptic-guided rescue techniques were successfully employed. Conventional direct laryngoscopy was unsuccessful in selected cases because of restricted cervical mobility and poor glottic visualization. All patients were intubated successfully without major airway trauma, neurological injury, or significant hypoxemia. Surgical procedures were completed uneventfully, and all patients had favorable postoperative outcomes with complete recovery. Conclusion: Patients with ankylosing spondylitis undergoing general anesthesia require meticulous preoperative planning, comprehensive airway assessment, and individualized airway management strategies. Advanced airway devices, particularly awake fibreoptic intubation and videolaryngoscopy, play a crucial role in securing the airway while minimizing cervical spine movement. This case series highlights the importance of early anticipation of difficult airway, adherence to difficult airway guidelines, and the availability of alternative airway devices to optimize perioperative safety and improve patient outcomes. Keywords: Ankylosing spondylitis; Difficult airway; General anesthesia; Awake fibreoptic intubation; Videolaryngoscopy; Airway management; Cervical spine rigidity; Difficult tracheal intubation; Perioperative care; Case series.