Ankylosing spondylitis and neuraxial anaesthesia--a 10 year review

Ankylosing Spondylitis (AS) patients present specific challenges to the anaesthetist. Both airway management and neuraxial access may prove to be difficult. The trend has been to deal with the airway challenge, and avoid neuraxial anaesthesia. In many cases this may lead to unnecessarily denying the patient neuraxial anesthesia (NA). We retrospectively reviewed the operative anaesthetic management of 51 consecutive AS patients who underwent 82 perineal or lower limb procedures and concurrent anaesthetic management at the Vancouver Hospital and Health Sciences Center from 1984 through 1994 (inclusive).

Anaesthetic records were used to document the type of anaesthetic used, i.e., general or regional, and the degree of difficulty experienced with each.

Of the 82 procedures performed on AS patients 16 (19.5%) were planned as NA. General anaesthesia (GA) was planned for 65 (79.3%) of the procedures. One procedure involved monitored anaesthetic care (MAC). Neuraxial access consisted of 13 spinal and three epidural attempts. Spinal anaesthesia was possible in 10 (76.2%) of cases and failed in 3 (23.8%). Epidural anaesthesia was unsuccessful in each attempt. There was no difference in demographics or duration of disease between the successes and failures.

These data suggest that spinal anaesthesia can be used as an alternative to general anaesthesia in AS patients undergoing perineal or lower limb surgery. There were no factors identified in this review that were predictive of success or failure in gaining neuraxial access.