SCCM Resource Library-Clinical Considerations for Airway Management in Patients with Ankylosing Spondylitis

Pdf Summary

Ankylosing Spondylitis (AS) is a significant inflammatory rheumatic disease that affects the spine and can extend to other joints and organs. It impacts millions in the U.S., causing major physiological changes that complicate clinical procedures, especially airway management. Patients with AS often experience ossification of spinal ligaments and spine fusion, resulting in a "bamboo" appearance on radiographic images and a consequent loss of spine mobility. This condition also frequently involves the cervical spine, making intubation challenging due to limited atlanto-occipital extension, restricted mouth opening, and an inability to lie supine.<br /><br />Patients with AS are at an increased risk of osteoporosis and spinal fractures, leading to severe complications like cervical spinal cord injuries, potentially resulting in permanent tetraplegia during intubation attempts. Anatomical changes associated with AS can further impede intubation by narrowing the temporomandibular joint space.<br /><br />Airway management for AS patients must be approached on a case-by-case basis, considering the patient’s unique anatomy, available equipment, and caregiver skills. Direct laryngoscopy is often ineffective and risky, while video-laryngoscopes and fiberoptic intubation offer safer alternatives. The use of intubating laryngeal masks (I-LMA) can be particularly advantageous during emergencies because they don't necessitate head or neck movement and allow lung ventilation.<br /><br />Beyond airway management, AS patients require careful consideration for other potential complications. They often have restrictive lung disease due to fused costovertebral joints and may suffer from pulmonary fibrosis. Cardiovascular issues like aortic valve insufficiency and complete heart block are also prevalent, necessitating preoperative evaluations, including echocardiograms and electrocardiograms.<br /><br />Spinal cord injury remains a critical risk, emphasizing the need for meticulous planning and special positioning strategies during surgical procedures to prevent catastrophic outcomes. Prone positioning, in particular, demands careful preoperative discussions and specialized equipment to protect the spinal structure and maintain alignment. This comprehensive approach is essential to minimize risks and improve outcomes for patients with ankylosing spondylitis during clinical interventions.

Asset Subtitle

Procedures, 2023, 0:10:00

Meta Tag

Content Type Critical Care Quick Study

Knowledge Area Procedures

Membership Level Associate

Membership Level Professional

Membership Level Select

Tag Airway Management

Year 2023

Keywords

Ankylosing Spondylitis

inflammatory rheumatic disease

spine fusion

airway management

ossification

intubation challenges

spinal fractures

video-laryngoscopes

restrictive lung disease

cardiovascular issues

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