We present a case involving a 60-year-old woman who had significant deformities in her cervical, thoracic, and lumbar spines along with ankylosing spondylitis. To manage her gastroesophageal reflux disease (GERD) and improve her functional mobility and quality of life, she was admitted for restorative surgery on her thoracic and lumbar spines. We proposed a surgical intervention for her condition. Due to the presence of a difficult airway and the unsuccessful standard intubation approach, we chose to utilize the Spray As You Go (SAGO) technique with Awake Fiberoptic Intubation. A "difficult intubation" cart, equipped with nasopharyngeal and oropharyngeal airways, a cricothyroidotomy kit, a gum elastic bougie, a fiberoptic bronchoscope, and an intubating laryngeal mask (ILMA), was prepared for the procedure.
There was no tachypnea, tachycardia, or hypoxia, and the patient was breathing spontaneously and tolerating the tube well. IV injections of propofol (2 mg/kg), fentanyl (2 μg/kg), and atracurium (0.5 mg/kg) were used to induce anesthesia. Using a modified Seldinger's approach, a triple lumen central venous catheter was used to cannulate the right femoral vein.