Primary osteolysis syndromes: beware of difficult airway

A case of safe airway management by fiber-optic nasotracheal intubation in general anesthesia in a pediatric patient with Hajdu-Cheney syndrome: a case report

BACKGROUND

Hajdu-Cheney syndrome (HCS) is an extremely rare disorder characterized by progressive acro-osteolysis. A unique facial structure and deformity of the cervical spine are associated with a difficult airway. Although several reports describe general anesthesia with orotracheal intubation for patients with HCS, there have been no reports of nasotracheal intubation with a risk of skull base fracture. We describe nasotracheal intubation for oral surgery in a patient with HCS.

CASE PRESENTATION

A 13-year-old girl with HCS was scheduled for dental surgery. Preoperative computed tomography revealed no abnormalities including fractures in the skull base or cervical spine. After confirming a lack of vocal cord paralysis by bronchofiberscopic inspection from the nose, general anesthesia was induced with sevoflurane, remifentanil, and rocuronium. Fiber-optic nasotracheal intubation was successfully performed without complications such as depletion of oxygen saturation and massive epistaxis, and the surgery was completed uneventfully. She was discharged the day after surgery with no anesthesia-related complications.

CONCLUSIONS

We were able to safely manage the airway of a patient with HCS by nasotracheal intubation under general anesthesia.

Anesthetic considerations in children with Hutchinson-Gilford progeria syndrome: A narrative review

BACKGROUND

Hutchinson-Gilford progeria syndrome is a rare disease in childhood that results in premature aging. The presence of multisystem derangements including skin, bone, and joint diseases and possibly a difficult airway makes the anesthetic management challenging. Because of the extremely low prevalence, experience is limited even for experienced pediatric anesthesiologists.

OBJECTIVE

To review the available literature on anesthesia for patients with Hutchinson-Gilford progeria syndrome and to give recommendations for establishing the best practice for patients with Hutchinson-Gilford progeria syndrome.

DESIGN

A narrative review of the rare existing literature.

DATE SOURCES

CENTRAL (Cochrane), EMBASE, Google Scholar, MEDLINE and PubMed.

ELIGIBILITY CRITERIA

Articles addressing anesthesia in patients with Hutchinson-Gilford progeria syndrome were included.

RESULTS

An overview of the current literature was made on anesthesia care for patients with Hutchinson-Gilford progeria syndrome. After screening the literature, only ten articles were found to be of interest and include some case reports and a correspondence. The focus points on how to perform anesthesia care in patients with Hutchinson-Gilford progeria syndrome and the entire perioperative care are suggested. The available data are limited and results need to be interpreted with caution.

CONCLUSION

The patients with Hutchinson-Gilford progeria syndrome are not just "frail" patients. Awareness concerning intubation difficulties is mandatory, and airway strategies must be addressed in advance. Although these patients present with the physiology of an elderly with accompanying comorbidities, emotionally they are only children and should be approached as such.

Anaesthetic Considerations in a Patient with Pycnodysostosis undergoing Caesarean Delivery

Pycnodysostosis is a rare congenital disorder with several implications, which might complicate anesthesia. Patients are more prone to fractures and have an anticipated difficult airway. We report a case of a 34-year-old woman with pycnodysostosis who underwent elective caesarean delivery under epidural blockade.