Failed rapid sequence induction in an achondroplastic dwarf

Problematic Airway and Anesthetic Dilemmas for Achondroplastic Dwarfism in the Acute Care Setting: A Case Report

Patients with achondroplasia often present with anatomical abnormalities and altered cardiopulmonary physiology that significantly increase their perioperative risk for cardiovascular and respiratory complications (e.g., worsening ventilation-perfusion mismatch, imminent desaturation, difficult airway). We describe a 34-year-old achondroplastic male presenting with altered mentation following a traumatic subdural hematoma that necessitated emergent craniotomy evacuation. Initial attempt at intubation was complicated by rapid desaturation and bradyarrhythmia. Subsequently, the patient went into cardiac arrest requiring cardiopulmonary resuscitation. A laryngeal mask airway (LMA) was secured and fiberoptic intubation was achieved in succession. Following return of spontaneous circulation (ROSC), a repeat CT scan showed the subdural hematoma to be stable in size and neurosurgery opted to delay his surgery for conservative management and close monitoring. This case highlights the unique airway challenges and anesthetic considerations in management of achondroplastic patients.

Chemotherapy dosing in achondroplastic dwarfism: a case report and review of literature

WHAT IS KNOWN AND OBJECTIVE

CASE DESCRIPTION: A 74-year-old female with achondroplastic dwarfism was diagnosed with ER-, BR- and HER2- breast cancer. No guideline currently exists to direct chemotherapy dosing in this population. She received neoadjuvant chemotherapy based on body surface area utilizing actual height and weight with dose-dense doxorubicin and cyclophosphamide followed by paclitaxel with the use of granulocyte colony-stimulating factor. Satisfactory clinical response and remission were achieved, and treatment proceeded without any significant toxicity or delays.

WHAT IS NEW AND CONCLUSION

In the absence of guideline recommendations, dosing chemotherapy based on actual height and weight in patients with achondroplastic dwarfism may be safe and appropriate.

Acute upper airway obstruction and emergency front of neck access in an achondroplastic patient

Dwarfism is defined as a failure to attain a height of 148 cm in adulthood. Achondroplasia is the most common form of short-limbed dwarfism. Although this condition is relatively rare, with an incidence of 0.5-1.5 per 10,000 live births, most medical professionals will come across the achondroplastic dwarf (AD) during their career. Faulty endochondral ossification produces the characteristic short stature phenotype, as well as severe craniofacial, central nervous system, spinal, respiratory and cardiac anomalies. These unusual characteristics may present airway management difficulties in elective as well as emergency situations. Within the literature there is very little information regarding the emergency insertion of a surgical airway in an adult AD. We present our experience of this situation in the form of a case report and a review of the relevant literature.

Achondroplasia: anaesthetic challenges for caesarean section

Pregnancy in women with achondroplasia presents major challenges for anaesthetists and obstetricians. We report the case of a woman with achondroplasia who underwent general anaesthesia for an elective caesarean section. She was 99cm in height and her condition was further complicated by severe kyphoscoliosis and previous back surgery. She was reviewed in the first trimester at the anaesthetic high-risk clinic. A multidisciplinary team was convened to plan her peripartum care. Because of increasing dyspnoea caesarean section was performed at 32weeks of gestation. She received a general anaesthetic using a modified rapid-sequence technique with remifentanil and rocuronium. The intraoperative period was complicated by desaturation and high airway pressures. The woman's postoperative care was complicated by respiratory compromise requiring high dependency care.