Difficult tracheal intubation is likely
(even without atlantoaxial instability) because of the presence of a short
neck, prominent, big jaws, macroglossia, and limited mouth opening. Tracheal
intubation should be performed either fiberoptically or, if possible,
conventionally with inline stabilization of the cervical spine. Restrictive
lung disease may render ventilation and oxygenation more challenging and may
preclude the use of neuraxial regional anesthesia. Proper patient
positioning is difficult because of atlantoaxial instability, dislocations
(hip, shoulder), deformities, and contractures affecting the musculoskeletal
system.