Ankylosing Spondylitis (AS)

Difficult airway - A fixed, flexed cervical spine with little or no neck extension, plus possible temporomandibular involvement, makes direct laryngoscopy and mask ventilation hard; awake fiberoptic intubation is often the safest plan, with video laryngoscopy available.

Fragile, unstable spine - The rigid, osteoporotic spine fractures easily and any manipulation risks a cord injury; avoid forceful neck movement, keep the head in its habitual position, and move the patient as a unit.

Neuraxial is difficult - Ossified ligaments and fused interspaces make midline access frequently impossible; a paramedian approach or ultrasound guidance helps, but plan for failure and a general-anesthetic backup.

Positioning - Position the awake patient to their comfortable baseline before induction and pad the fixed deformities; forcing a flat or extended posture can fracture the spine.

Cardiopulmonary - Reduced chest-wall compliance limits reserve; screen for aortic regurgitation and conduction disease.

A chronic inflammatory arthritis of the axial skeleton associated with HLA-B27. Progressive ossification fuses the spine (the classic bamboo spine) and sacroiliac joints, producing a fixed flexion deformity and a rigid, immobile cervical spine with reduced chest expansion. The fused, osteoporotic spine fractures with even minor trauma - often at unstable transverse levels - and atlantoaxial subluxation can occur. Extra-articular disease includes aortic regurgitation, cardiac conduction defects, and apical pulmonary fibrosis.