ORIGINAL RESEARCH GlideScope video laryngoscopy use tracheal intubation in patients with ankylosing spondylitis: a series of four cases and literature review Vahap Saricicek • Ayse Mizrak • Rauf Gul • Sitki Goksu • Mehmet Cesur Received: 29 May 2013 / Accepted: 11 September 2013 / Published online: 18 September 2013 Ó Springer Science+Business Media New York 2013 Abstract Airway management in patients with ankylos- ing spondylitis (AS) is a challenging problem for anes- thesiologists. The GlideScope video laryngoscope (GVL) is designed to assist tracheal intubation for patients with a difficult airway. The aim of the study was to report the successful intubation by GVL of four AS patients, and to discuss the use of GVL for tracheal intubation in patients with AS by performing a review of the literature. Four patients with chronic, severe AS were evaluated preoper- atively; all had features associated with a difficult direct laryngoscopy. We performed the necessary preparations for difficult airway and intubation. Patients were kept in supine position, with their head and neck supported on pillows. Following sufficient preoxygenation, patients received i.v. remifentanil at 1 lg kg -1 , propofol at 2 mg kg -1 , and succinylcholine at 1 mg kg -1 . GVL intu- bation was provided after full muscle relaxation. GVL is reasonable alternative to awake fiberoptic bronchoscopy or any other device, as it appears that less training and skill is involved in the actual intubation process. Adequate lar- yngeal exposure was obtained in all patients were suc- cessfully intubated in the first attempt. As with any challenging airway management, it is essential to have a rescue strategy. We believe that GVL can be a good alternative for oral endotracheal intubation in patients with AS. This series is very small and the reader should be very cautious about drawing broad conclusions regarding the GVL and patients with AS. Keywords GlideScope video laryngoscopy Á Anklylosing spondylitis Á Difficult airway 1 Introduction Ankylosing spondylitis (AS) is a chronic, progressive and autoimmune spondyloarthropathy. AS first affects the sacroiliac joints and spine, eventually causing fusion and rigidity in the spine (bamboo spine) [1]. Difficulty in intubation is associated in AS that involves the stiffness of the cervical spine and of the atlantooccipital, temporo- mandibular and cricoarytenoid joints. In patients with chronic cervical kyphosis, there is significant risk of neu- rological injury with any excessive extension of the neck. Fixed cervical flexion deformities limit access to the tra- chea, rendering tracheostomy impossible [2]. Video laryngoscopes are devices that have been used in anesthesia practice over the past 10 years. Numerous studies have demonstrated that video laryngoscopy provided better results and epiglottic appearance in comparison to traditional direct laryngoscopy (DL), especially in conditions involving difficult intubation [3]. The GlideScope video laryngoscope (GVL) (Verathon Medical, Bothell, WA, USA) is an ana- tomically shaped, rigid, fiberoptic video laryngoscope that has been in clinical use since 2001 [4]. It has been shown to facilitate tracheal intubation by improving laryngeal view in several studies covering a wide spectrum of general surgical patients [4–7]. The aim of the study was to report the successful intu- bation by GVL of four AS patients, and to discuss the use of video laryngoscope for tracheal intubation in patients with AS by performing a review of the literature. All patients signed a written informed consent for publication. V. Saricicek (&) Á A. Mizrak Á R. Gul Á S. Goksu Á M. Cesur Department of Anesthesiology and Reanimation, Faculty of Medicine, University of Gaziantep, 27310 Sahinbey, Gaziantep, Turkey e-mail: vahapsaricicek@hotmail.com 123 J Clin Monit Comput (2014) 28:169–172 DOI 10.1007/s10877-013-9511-0