The intubating laryngeal mask airway in severe ankylosing spondylitis

Purpose: To evaluate the use of inhalational induction followed by intubati on through the intubating laryngeal mask (ILM) for patients with severe ank ylosing spondylitis undergoing elective surgery who prefer airway managemen t under anesthesia. Methods: Nine patients undergoing a total of 1 procedures were enrolled in the study. Fentanyl 2 mug(.)kg(-1), midazolam 0.035 mg(.)kg(-1) and sevoflu rane in oxygen 100% were used for induction. The ILM was inserted when the end-tidal sevoflurane concentration reached 3%. After an effective airway w as established, atracurium 0.5 mg(.)kg(-1) was given. A polyvinyl chloride tube in the reversed position using a blind technique was used to intubate the trachea. Results: The ILM provided an effective airway on 11/11 occasions at the fir st attempt. Intubation was successful at the first attempt on 7/11 occasion s, at the second attempt on 2/11 and at the third attempt in 1/11. Intubati on failed in one patient. The mean (range) minimal oxygen saturation was 99 .4% (97-100%). There were no problems with ILM removal. Conclusion: Inhalational induction followed by ILM insertion and blind intu bation is a reasonable option in patients with severe ankylosing spondyliti s undergoing elective surgery who prefer airway management under anesthesia .