ANKYLOSING-SPONDYLITIS AND NEURAXIAL ANESTHESIA - A 10-YEAR REVIEW

Purpose: Ankylosing Spondyltis (AS) patients present specific challeng es to the anaesthetist. Both airway management and neuraxial access ma y prove to be difficult. The trend has been to deal with the airway ch allenge, and avoid neuraxial anaesthesia. In many cases this may lead to unnecessarily denying the patient neuraxial anaesthesia (NA). We re trospectively reviewed the operative anaesthetic management of 51 cons ecutive AS patients who underwent 82 perineal or lower limb procedures and concurrent anaesthetic management at the Vancouver Hospital and H ealth Sciences Center from 1984 through 1994 (inclusive). Source: Anae sthetic records were used to document the type of anaesthetic used, i. e., general or regional, and the degree of difficulty experienced with each. Principal findings: Of the 82 procedures performed on AS patien ts 16 (19.5%) were planned as NA. General anaesthesia (GA) was planned for 65 (79.3%) of the procedures. One procedure involved monitored an aesthetic care (MAC). Neuraxial access consisted of 13 spinal and thre e epidural attempts. Spinal anaesthesia was possible in 10 (76.2%) of cases and failed in 3 (23.8%). Epidural anaesthesia was unsuccessful i n each attempt. There was no difference in demographics or duration of disease between the successes and failures. Conclusions: These data s uggest that spinal anaesthesia can be used as an alternative to genera l 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.