Supraglottic Airway Insertion in Semi Fowler Position Due to Severe Thoracic Hyperkyphosis: A Case Report

Kyphosis, an excessive convex spinal curvature, complicates anaesthetic management due to respiratory and cardiovascular limitations. Severe cases increase the risk of difficult airway management and post-operative complications. A 77-year-old female with severe thoracic kyphosis and stage 5 CKD on hemodialysis presented with a swollen right brachiocephalic fistula. Her deformity prevented supine positioning, requiring anaesthetic modifications. Given the anticipated difficult airway, a comprehensive emergency plan was implemented. The patient was positioned in a semi-Fowler (30-degree head-up tilt) position, and a second-generation supraglottic airway device (ProSeal) was successfully inserted. She remained hemodynamically stable, with mild post-operative wheezing managed by nebulization. She was discharged on the second postoperative day without complications. Severe kyphosis distorts airway anatomy, limiting neck mobility and complicating intubation. Supraglottic airway devices offer a safe alternative in such cases. Comorbid conditions like COPD heighten the risk of post-operative respiratory issues, requiring close monitoring. Anaesthetic management of severe kyphosis demands early recognition, meticulous preparation, and alternative airway strategies. Supraglottic airway devices provide a safe and effective option, emphasizing the need for individualized perioperative planning and teamwork.