Ankylosing Spondylitis Flashcards
1
Q
Definition and incidence
A
Inflammatory arthritis of the sacroiliac joints and spine, leading to ankylosis and ‘bamboo spine’.
Associated with hLA-B27 in >90% of cases.
Commoner in ♂, with peak age onset in the 3rd decade. Important anaesthetic implications are both articular and non-articular
2
Q
Articular Manifestations
A
- progressive kyphosis and fixation of the spine may hinder intubation. Conventional intubation and tracheostomy may be impossible. AAS and myelopathy can occur rarely. there may be limited mouth opening from temporomandibular involvement. Use of intubating LMA (ILMA) described, but fibreoptic intubation usually preferred.
- At risk of occult cervical fracture with minimal trauma—ensure the head is supported and not left self-supporting.
- Cricoarytenoid arthritis may make cords susceptible to trauma.
- Axial skeletal involvement may make neuraxial block difficult or impossible. Spinal anaesthesia using a paramedian approach appears to be the most practical technique for neuraxial block. possible increased risk of epidural haematoma with epiduralblock.
- Limited chest expansion may lead to post-operative pulmonary complications. effective external cardiac massage may be impossible.
- deformity leads to difficulty with positioning, particularly if a prone position is required.
3
Q
Non-Articular Manifestations
A
- Fibrosing alveolitis may occur, exacerbating post-operative hypoxia.
- AR (1%). Mitral valve involvement and conduction defects arerare.
- Amyloid may cause renal involvement.
- Cauda equina syndrome may occur in long-standingcases.
- Associated use of NSAIds and dMARds
