anaesthetic management of patient with ankylosing spondylitis posted for fracture of neck of femur

introduction: management of a case of ankylosing spondylitis can be very challenging where the airway and the central neuraxial blockade , both are difficult.Difficult airway management is because of limited or no cervical spine mobility and possible temporomandibular joint disease.Neuraxial blocks is technically difficult in these patients because of the severe,rigid kyphoid spinal deformity and due to ossification of ligaments and diminution of intervertebral spaces.We report the successful management of a patient with the above features under general anaesthesia with fibreoptic intubation Case report: 46 year old female ASA grade 3 with history of fracture neck of right femur and right humerus mid shaft fracture scheduled for hemiarthroplasty to right femur.case was managed under general anaesthesia with awake fibreoptic intubatuon despite of failed lumbar puncture Conclusion: the use of an awake fibreoptic nasal intubation was useful in our patient and should be considered in difficult airway patients