Anesthetic consideration for patients suffering from achondroplasia - A case report

Achondroplasia is associated with craniofacial abnormality, musculoskeletal deformations, and respiratory, cardiovascular abnormalities. So, anesthetic management is one of clinical challenges. Herein, we report and discuss a case of achondroplastic patient underwent osteosynthesis for femur fracture, which was chosen on the base of patient’s anatomical and physiological characteristics. The patient had thoracolumbar kyphosis (21.8°), previous spine surgery, short neck, obstructive sleep apnea, and mild cervical limitation. Intubation was conducted with smaller cuffed endotracheal tube under videolaryngoscope guidance. Mechanical ventilation was applied with volume control mode, using a tidal volume of 8-10 ml/kg without positive end-expiratory pressure. The patient was supine after placing support under shoulders and head during intubation and surgery. Intraoperative body temperature was maintained using air-forced waring blanket. Complete and careful preoperative evaluation is absolutely important to select the appropriate anesthetic method. Ideal anesthetic management in each case should be based on an individualized decision-making.