Anesthesia management of morbid obesity and ankylosing spondylitis with a difficult airway: a case report

The anesthesia management in morbidly obese patients is challenging, because there may also be a number of complications in addition to predictable difficulties associated with airway and ventilation management. Potential complications require careful preoperative evaluation and intraoperative management to ensure rapid recovery and minimize adverse effects from anesthesia.

This study involved a 39-year-old male patient who had ankylosing spondylitis complicated with morbid obesity (body mass index =48.8). He had severely limited head and neck mobility, severe obstructive sleep apnea syndrome as well as a high STOP-BANG score and Mallampati class IV. After administering local airway anesthesia, awake tracheal intubation was conducted under the guidance of fiberoptic bronchoscopy. Total intravenous anesthesia was adopted intraoperatively, and awake extubation was performed 5 minutes after the completion of the operation. The patient experienced no nausea or vomiting, and the pain score assessed by the Visual Analogue Scale was only 1-2 points. He did not suffer from painful memories relating to anesthesia.

We report a case of concurrent ankylosing spondylitis and morbid obesity associated with a difficult airway successfully treated with total intravenous anesthesia and awake intubation. This approach can be referred in patients with similar conditions.