Difficult airway with difficult regional anaesthesia for lower limb orthopaedic surgeries in patients with ankylosing spondylitis- What should we opt for?

A difficult airway in an ankylosing spondylitis patient may be a nightmare for an anaesthesiologist. We report a case of a 60-year-old man who was scheduled for open reduction and internal fixation of left femur shaft fracture. He was diagnosed with ankylosing spondylitis with multiple extra-spinal joint involvements. He had hypertension and COPD with a history of exposures to general anesthesia twice in the past 15 years. He was a chronic tobacco chewer and had a difficult airway. He was managed successfully with a paramedian approach of spinal anaesthesia. DOI: http://dx.doi.org/10.4038/slja.v20i1.4274 Sri Lankan Journal of Anaesthesiology 20(1): 39-42 (2012)