Gil S, Jamart V, Borrás R, Miranda A
Departamento de Anestesiología, Reanimación y Terapéutica del Dolor, Institut Universitari Dexeus, Barcelona.
Rev Esp Anestesiol Reanim. 2007 Feb;54(2):128-31.
We report a case of difficult airway management in a 41-year-old man with ankylosing spondylitis who was scheduled for total left hip replacement surgery. After several failed attempts to achieve regional anesthesia, we converted to general anesthesia with orotracheal intubation using a fiberoptic bronchoscope. Ankylosing spondylitis leads to fibrosis, ossification, and ankylosis along the spinal column and sacroiliac articulations. Cervical column and atlantooccipital articulation mobility are reduced and in severe cases the cervical vertebrae become fixed in a flexed position. This portion of the spine is also the most susceptible to fracture, particularly in hyperextension, an event that could lead to damage to the cervical spinal cord during maneuvers to manage the airway. Patients with this condition may also have temporomandibular joint involvement, further complicating airway management. We report the case of a patient with ankylosing spondylitis with fixation along the entire spine. The airway was managed by intubation with a fiberoptic bronchoscope. Spontaneous ventilation was maintained during the maneuver, and sedation was achieved with perfusion of remifentanil as the only anesthetic agent following failure of intradural anesthesia.
我们报告一例41岁强直性脊柱炎男性患者的困难气道管理病例，该患者计划进行全左髋关节置换手术。在多次尝试区域麻醉失败后，我们改用全身麻醉并使用纤维支气管镜经口气管插管。强直性脊柱炎会导致沿脊柱和骶髂关节的纤维化、骨化和关节强直。颈椎和寰枕关节活动度降低，严重时颈椎会固定在屈曲位。脊柱的这一部分也最易发生骨折，尤其是在过伸时，这一情况可能在气道管理操作过程中导致颈脊髓损伤。患有这种疾病的患者也可能累及颞下颌关节，使气道管理更加复杂。我们报告了一例整个脊柱均有固定的强直性脊柱炎患者病例。通过纤维支气管镜插管进行气道管理。操作过程中维持自主通气，在硬膜内麻醉失败后，仅使用瑞芬太尼输注作为麻醉剂实现了镇静。
