Abstract
We describe three patients with long-standing ankyolsing spondylitis (AS) who underwent lower limb joint surgery under spinal anaesthesia. At preoperative assessment, it was considered that intubation of the trachea was likely to be difficult or impossible and previous general anaesthesia was associated with increased morbidity. Midline approach spinal anaesthesia failed but the lateral approach was successful. Spinal anaesthesia was induced using a 24 gauge Sprotte (Pajunk) needle with 3.5 ml heavy bupivacaine 0.5% at the L3–4 interspace with the patients in the sitting position. This resulted in adequate sensory blockade for the surgical procedure. None of the patients required airway interventions but equipment and aids to secure airway were available.
Résumé
Nous décrivons la prise en charge de trois patients souffrant de spondylite ankyolsante avancée soumis à une chirurgie articulaire au membre inférieur sous anesthésie rachidienne. L’évaluation préopératoire laissait entrevoir une intubation difficile ou même impossible. Les suites des anesthésies générales antérieures s’étaient avérées de plus en plus compliquées. L’approche médiane du rachis a échoué, mais la latérale a réussi. L’anesthésie rachidienne a été réalisée avec une aiguille 24 G Sprotte (Pajunk) avec 3,5 ml de bupivacaïne hyperbare à 0,5% en position assise à L3/L4. Le bloc sensitif a été suffisant pour l’intervention. L’appareillage et l’aide nécessaires pour intervenir sur les voies aériennes étaient prêts en cas de besoin mais n’ont pas été utilisés.
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References
Bluestone R. Arthritis and allied conditions. In: McCarty DJ (Ed.). A Textbook of Rheumatology. Philadelphia: Lee and Febiger, 1979; 610–32.
Sinclair JR, Mason RA. Ankylosing spondylitis. The case for awake intubation. Anaesthesia 1984; 39: 3–11.
McKenzie PJ, Blogg CE. Orthopaedic and plastic surgery. In: Nimmo WS, Smith G (Eds.). Anaesthesia. Oxford: Blackwell Scientific Publications, 1989; 721.
Eisele JH Jr. Connective tissue diseases. In: Katz J, Benumof JL, Kadis LB (Eds.). Anesthesia and Uncommon Diseases, 3rd ed. Philadelphia: W.B. Saunders, 1990; 653.
Loach A. Anaesthesia for Orthopaedic Patients. London: Edward Arnold, 1983; 28.
DeBoard JW, Ghia JN, Guilford WB. Caudal anesthesia in a patient with ankylosing spondylitis for hip surgery. Anesthesiology 1981; 54: 164–6.
Lee JA, Atkinson RS, Watt MJ. Sir Robert Macintosh’s Lumbar Puncture and Spinal Analgesia: Intradural and Extradural, 5th ed. Edinburgh: Churchill-Livingstone, 1985; 164.
Calin A. Ankylosing spondylitis. In: Maddison PJ, Isenberg DA, Woo P, Glass DN (Eds.). Oxford Textbook of Rheumatology, vol 2. Oxford: Oxford University Press, 1993; 671–83.
Simmons EH. The surgical correction of flexion deformity of cervical spine in ankylosing spondylitis. Clin Orthop 1972; 86: 132–43.
Benumof JL. Management of the difficult adult airway: with special emphasis on awake tracheal intubation. Anesthesiology 1991; 75: 1087–110.
Benumof JL. Management of the difficult airway: the ASA algorithm. Review Course Lecture. Presented at the 67th Congress of the International Anesthesia Research Society San Diego, California March 19–23, 1993: 83–91.
Muravchick S. The Anesthetic Plan: From Physiologic Principles to Clinical Strategies. St.Louis: Mosby Year Book, 1991.
Hains JD, Gibbin KP. Fibreoptic laryngoscopy in ankylosing spondylitis. J Laryngol Otol 1973; 87: 699–703.
Hyman SA, Rogers WD, Bullington JC III. Cervical osteotomy and manipulation in ankylosing spondylitis: successful general anesthesia after failed local anesthesia with sedation. J Spinal Disord 1990; 3: 423–6.
Simmons EH. Kyphotic deformity of the spine in ankylosing spondylitis. Clin Orthop 1977; 128: 65–77.
Wittmann FW, Ring PA. Anaesthesia for hip replacement in ankylosing spondylitis. JR Soc Med 1986; 79: 457–9.
Ward RJ, Bonica JJ, Freund FG, Akamatsu T, Danziger F, Englesson S. Epidural and subarachnoid anesthesia. Cardiovascular and respiratory effects. JAMA 1965; 191: 275–8.
de Jong RH. Arterial carbon dioxide and oxygen tension during spinal block. JAMA 1965; 191: 94–8.
Patel M, Samsoon G, Swami A, Morgan B. Posture and the spread of hyperbaric bupivacaine in parturients using the combined spinal epidural technique. Can J Anaesth 1993; 40: 943–6.
Atkinson RS, Rushman GB, Davies NJH. Lee’s Synopsis of Anaesthesia, 11th ed. London: Butterworth Heinemann 1993; 708.
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Kumar, C.M., Mehta, M. Ankylosing spondylitis: lateral approach to spinal anaesthesia for lower limb surgery. Can J Anaesth 42, 73–76 (1995). https://doi.org/10.1007/BF03010575
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DOI: https://doi.org/10.1007/BF03010575