Ankylosing spondylitis is a chronic, autoimmune disease affecting the spine. Involvement of the cervical spine, atlanto occipital, temporomandibular and cricoarytenoid joints leads to difficulty in airway management and securing airway by conventional laryngoscopy. We report a case of severe ankylosing spondylitis with severe restriction in neck movements and limited mouth opening. Conventional laryngoscopy and endotracheal intubation was impossible in this patient as there was no movement at the atlanto-occipital join. So, we decided to use King Vision TM video laryngoscope for intubation which proved to be of great use.
Recent guideline on difficult intubation has included video laryngoscope as an initial approach for intubation. A young patient posted for nasophryngeal angiofibroma where even mask ventilation was difficult due to stuffiness of the nose. Moreover angiofibroma had penetrated the hard palate and was hanging into the posterior pharyngeal wall. Also the nasal bridge of the patient was broadened and there was a diffuse swelling especially over the left maxillary area. In such a situation paralysing the patient could have lead to catastrophy. So an awake intubation using king vision video laryngoscope was planned. After proper preparation for awake intubation, glottis opening was visualzed using king vision video laryngoscope and then a bougie was introduced into the glottis opening over which endotracheal tube was rail roaded. Using this device was very easy to handle and visualization of the vocal cord on the monitor was panoramic.
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