• All patients have severely restricted mouth opening and a fibreoptic intubation is the airway management technique of choice • They may be elderly or have conditions such as rheumatoid arthritis, so medical comorbidities are common32 • A nasal tracheal tube is necessary • A throat pack is mandatory but may be difficult to insert as mouth opening is limited • Use a viscous ointment to protect the eye; avoid tapes on the side of the surgery as the surgeon may want to see the eye • Surgery is prolonged • The surgeon may request moderate hypotension • There is a risk of sudden, severe bleeding owing to the proximity of the carotid artery to the ankylosed joint • Invasive arterial monitoring is advisable • Mouth opening may be improved after surgery, but the joint is delicate and vigorous mouth opening or mandibular manipulation should be avoided • Postoperative high dependency care is advisable for the first 24 hours • This is a painful procedure; a PCA is required postoperatively |
• All patients have severely restricted mouth opening and a fibreoptic intubation is the airway management technique of choice • They may be elderly or have conditions such as rheumatoid arthritis, so medical comorbidities are common32 • A nasal tracheal tube is necessary • A throat pack is mandatory but may be difficult to insert as mouth opening is limited • Use a viscous ointment to protect the eye; avoid tapes on the side of the surgery as the surgeon may want to see the eye • Surgery is prolonged • The surgeon may request moderate hypotension • There is a risk of sudden, severe bleeding owing to the proximity of the carotid artery to the ankylosed joint • Invasive arterial monitoring is advisable • Mouth opening may be improved after surgery, but the joint is delicate and vigorous mouth opening or mandibular manipulation should be avoided • Postoperative high dependency care is advisable for the first 24 hours • This is a painful procedure; a PCA is required postoperatively |
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