Ankylosing spondylitis (AS) is a rare disease. Initially, patients with AS often feel pain in the lumbar and gluteal regions, and their movements gradually become limited. We report the anesthetic management of a 32-year-old male patient with ankylosing spondylitis. The patient has had a medical history of AS since the age of 30 years and had been receiving treatment with infliximab as an outpatient at the Department of Internal Medicine. The patient had difficulty tilting his neck backwards, and he had a restrictive ventilator impairment because of AS. During the operation, we extracted both third molar teeth of the lower jaw under general anesthesia using a laryngeal mask airway (LMA). After the operation, the patient's surgical wound became infected despite the long-term administration of antibiotics. During operations under general anesthesia for patients with AS, 3 important points should be considered : tracheal intubation, respiratory care, and the patient's posture. Tracheal intubation is often difficult to perform in patients with AS because of a rigid neck and temporomandibular joint. In such cases, the use of devices such as an LMA or video intubation system can simplify tracheal intubation. Regarding respiratory care, patients with AS sometimes have restrictive ventilator impairment. During general anesthesia for such patients, the anesthesiologist should pay close attention to the patient's respiratory condition. Finally, patients with AS often have limited mobility. It is important to confirm whether the patient can feasibly maintain the posture required for intubation and surgery prior to the start of general anesthesia and to ensure that the patient's head is held immobile during the operation.

  The presently reported patient developed an infection at the wound site. Thus, infection control in patients taking infliximab should be investigated further.