Anaesthesia
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A flexible fibreoptic laryngoscope was used to facilitate the passage of a long polyvinyl chloride tracheal tube into the left main bronchus during repair of a tracheo-oesophageal fistula situated near the carina in a patient in whom intubation with a double-lumen endobronchial tube was difficult. Close monitoring of neuromuscular transmission using a peripheral nerve stimulator also contributed to the successful anaesthetic management of this patient.
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The use of atracurium besylate, in small incremental doses, with continuous monitoring of neuromuscular function, is described during upper abdominal surgery in a patient with myasthenia gravis.
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The major problems of long-standing ankylosing spondylitis are described and the surgical and anaesthetic literature reviewed. The upper airway problems are discussed with reference to four cases and the advantages of an awake intubation technique are stressed.