Ankylosing spondylitis

 

Issues:

Airway

·        Stiff neck

·        Atlanto-axial instability (?)

·        Risk of fracture during laryngoscopy

-> Hyperangulated VL vs AFBI

Breathing

·        Non-compliant chest wall

·        Pulmonary fibrosis

-> ↑RR, ↓VT

Circulation

·        Aortic regurgitation

·        Myocarditis

·        Conduction disease

·        Cardiomyopathy

·        Pericardial effusion

-> TTE before major surgery

Disability (neuro)

Brain:

·        Chronic pain / opioids

·        Depression

Neuraxis:

·        Fusion

·        Immobility

·        Spondylolisthesis

·        Epidural space obliteration

·        Higher risk of epidural haematoma (ASRA)

Other

·        Anaemia of chronic disease

·        Analgesic nephropathy

Medications

·        NSAID

·        DMARD -> marrow suppression, infection risk

·        Glucocorticoid -> toxicity, insufficiency

·        Opioids

 

https://www.anesthesiaconsiderations.com/ankylosing-spondylitis-considerations

 

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