Ankylosing spondylitis (AS) is a chronic inflammatory disease included in the group of seronegative spondyloarthropathies that affects mainly the spine, with progressive rigidity and functional limitation. Patients with AS may require surgery of any type and these patients present specific challenges to the anaesthesiologist as a consequence of the potential difficult airway, neuraxial access, cardiovascular and respiratory complications. There is also an increased risk of neurological complications in the peri–operative period as surgical positioning of these patients under anaesthesia is also demanding due to risk of iatrogenic fractures and spinal cord trauma. Awake fibreoptic intubation is safest option in those patients with a potentially difficult airway as it allows continuous neurological monitoring while achieving a definitive airway . This article reviews the anaesthetic issues in patients with ankylosing spondylitis. The challenge to the anaesthetist is in the understanding of these issues so that appropriate management can be planned and undertaken.