Background :Ankylosis spondylitis is a chronic inflammatory disease of the joints which causes fusion of the bones in the spine, which causes loss of flexibility of the back and neck. Managing a case of ankylosis spondylitis can be difficult and challenging as airway and vertebral column are deformed.

Methodology : We report a case of cholelithiasis with AS posted for open cholecystectomy under GA in which ET intubation was aided using GEB. Preoperative examination revealed decreased mobility of entire vertebral column. Airway assessment revealed MPG –III with completely reduced neck movements. Written informed consent obtained and difficult airway cart was kept ready. After induction with propofol and sevoflurane effective mask ventilation confirmed. Direct laryngoscopy was done , grade III of Cormack and Lehane s view noted then 15 french 60 cm long GEB passed under epiglottis and the ETT was slided over the GEB into the trachea and position confirmed with capnography.

Results : GEB is a standard technique of achieving endotracheal intubation in difficult airway scenario. GEB can be used blindly or aided by indirect laryngoscopy with a laryngeal mirror or LMA.

Discussion : Patients with chronic disease of the spine represent specific challenges to the anaesthesiologist. Other methods include use of fibre-optic bronchoscope but these equipment is expensive and may not be available in most places.

Conclusion : Vigilance and meticulous preoperative preparedness for difficult airway is the key to success.