ABSTRACT : Difficult airway is a night mare even for the most experienced anaesthesiologist. Anticipation through a thorough pre operative evaluation, attention to the details in keeping the various equipments ready in case of need and alertness to tide over any untoward complications are the keys to success in such difficult situations. We describe two cases of ankylosing spondylitis, in which limited neck extension and deformed airway lead to difficulties in securing airway though managed successfully.

METHODS : First case was a 32 year old lady with ankylosing spondylitis who was posted for correction of spine deformity. This patient had dorso lumbar deformity, inability to sleep supine and restricted neck movement. She had restrictive lungs on pulmonary function test. She was operated in prone position under general anaesthesia. Intra and post operative period was uneventful. Second case was a 30 year old gentleman with history of trauma to spine in the past and incidentally diagnosed ankylosing spondylitis. He was posted for total hip replacement surgery . He had restricted neck movements and intubation was deemed difficult. He underwent the procedure in spinal/epidural anaesthesia. Intra and post operative period was uneventful.

RESULTS : Discussion: Ankylosing spondylitis presents with fusion of axial skeleton with decreased or no cervical spine mobility, fixed flexion deformity of thoracolumbar spine and temporomandibular joint disease also not forgetting the added restrictive lung pathology. Securing airway and ventilation in prone position adds on to comorbidity in posing the impending grievous complications during the surgery. Techniques like Fibre optic intubation, retrograde intubation are a excellent options in securing airway. Securing prone position and ventilation for such prolonged spine surgeries needs vigilance and expertise.

CONCLUSIONS : Modern day surgery frequently takes its toll on the anaesthesiologist. Proper and timely use of the available resources may lead to difficult airway being not so difficult.