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mocdoc

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I saw something interesting the other day, a post-op patient was brought to the ICU and I noticed in the PMH that the patient had a history of ankylosing spondylitis with bamboo spine. The patient was intubated in the usual manner using direct laryngoscopy and his hospital corse was uncomplicated.

Is there any contraindication to direct laryngoscopy in this patient and how would you have managed the airway?

Or is this just a boring case with nothing really there? If this is the case anyone care to discuss problems they have seen with direct laryngoscopy?

Ciao
 

militarymd

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if the cervical spine is fused....DL yields nada.
 
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Laryngospasm

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mocdoc said:
I saw something interesting the other day, a post-op patient was brought to the ICU and I noticed in the PMH that the patient had a history of ankylosing spondylitis with bamboo spine. The patient was intubated in the usual manner using direct laryngoscopy and his hospital corse was uncomplicated.

Is there any contraindication to direct laryngoscopy in this patient and how would you have managed the airway?

Or is this just a boring case with nothing really there? If this is the case anyone care to discuss problems they have seen with direct laryngoscopy?

Ciao

Check airway preoperatively, if neck movement and mouth opening is fine, then should be no different. Believe cervical spine is often spared, if the patient has dentures thats icing on the cake(as always) :)
 

Atropine

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As mentioned by others, it involves lumbar spine and not c-spine. The vertebral bodies literally fuse together. Interesting because more likely to be an issue with proper positioning prior to epidurals if the patient can't flex. However, it's unclear (to me) if this affects the ligamentum flavum and other ligaments and thus, the actual placement of the epidural. Anyone actually know the answer to that?
 
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