Anaesthesia Management in a Patient With Ankylosing Spondylitis for Emergency Caesarean Section

A 34-year-old second gravida at 38 weeks presented with decreased fetal movement and was planned for emergency cesarean section for a poor Bishop’s score. She had pre-eclampsia and hypothyroidism, for which she was on medications for one week. On airway examination, mouth opening was >3 cm with Modified Mallampati class III and restricted neck movements. The lumbar spine had limited movement with loss of lumbar lordosis. She had consumed a solid meal three hours ago. Subarachnoid space could be located with difficulty via the paramedian approach, but there was no sensory or motor block. Endotracheal intubation was attempted with a Macintosh laryngoscope, but a Cormack Lehane grade IV view was obtained. The KingVision videolaryngoscope was then used to successfully secure the airway. Postoperative lumbar spine X-ray showed “bamboo spine”, suggestive of ankylosing spondylitis. Ankylosing spondylitis is rare in pregnancy. This case highlights the importance of the videolaryngoscope as a tool for airway management in anticipated difficult obstetric cases.