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Management of Difficult Endotracheal Intubation and Challenging Transesophageal Echocardiography Probe Insertion in a Patient With Ankylosing Spondylitis

ANKYLOSING SPONDYLITIS (AS) is a chronic inflammatory disease of unknown etiology characterized by inflammation of spinal joints. 1,2 In many patients, the disease is progressive and associated with axial musculoskeletal deformities and extra-articular manifestations. 1 Anesthesiologists have recognized the implications of advanced AS on the cervical spine and the occurrence of difficult endotracheal intubation (EI). 3-5 In turn, several reports describe various techniques to achieve successful EI and/or airway control. 6,7 Transesophageal echocardiography (TEE) is a perioperative diagnostic and monitoring tool used during cardiac surgery 8 ; however, there are no reports of prolonged or difficult esophageal intubation with the TEE probe in patients with AS. In this report, a patient with advanced AS is described in whom difficult EI and challenging TEE probe insertion were managed with a Supraglottic Retractor (SGR) (AMRAD, LLC, Sugar Land, TX; Fig 1 ). </P><h5>Case Report</h5> A 72-year-old man (height, 68 inches and weight, 70 kg) presenting with exertional angina and a positive exercise stress test was scheduled for cardiac catheterization, which revealed a 60% proximal stenosis in the left main coronary artery (most significant at the ostium), total occlusion of the proximal left anterior descending coronary artery, several stenotic areas in http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Cardiothoracic and Vascular Anesthesia Elsevier
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