Abstract

Introduction: Achondroplasia is most common cause of dwarfism caused by FGFR-3 gene mutation. It possess  anesthetic challenges due to multiorgan system involvement, spine abnormality, difficulty in mask ventilation and  endotracheal intubation. Case Report: A 38yr old, female, case of achondroplastic dwarfism with history of bronchial asthma and  hypothyroidism was posted for abdominal hysterectomy. She weighed 30 kgs and 43 cm in height. Spine examination showed thoracolumbar kyphoscoliosis. Airway assessment revealed large tongue, receding  mandible, Mallampatti class IV. Pulmonary function test suggested mild restrictive disease. Difficult intubation trolley was kept ready. Routine monitoring, radial artery cannulation done for invasive blood  pressure monitoring. Patient was given general anesthesia. On laryngoscopy, CL grade III view was obtained, with  the aid of bougie endotracheal tube was placed. Delayed recovery time from general anesthesia was encountered,  neuromuscular monitoring was doneandreversed and extubated uneventfully. Conclusion: we present a successful anesthetic management of a dwarf patient with bronchial asthma and  hypothyroidism who underwent hysterectomy. We emphasize the risk of neurological injury while extending the  neck during laryngoscopy for tracheal intubation due to anatomical abnormalities in these patients. A detailed  pre anesthetic evaluation evaluation and planning is utmost important and the anesthetic technique has to be  individualized based on the patients anatomical characterstics and associated co-morbidities. Keywords: Dwarf, Asthma, Hypothyroidism. Key Messages: A 38 yrs old female patient with achondroplastic dwarfism (43cm tall) with associated  comorbidities like bronchial asthma and hypothyroidism, thoracolumbar kyphoscoliosis and mild restrictive  lung disease posted for abdominal hysterectomy possesses various anesthetic challenges. Since multiple systems  are involved preanesthetic evaluation, preoperative optimization of the patient and planning of anesthesia  is important. As the spread of drug in regional anesthesia is unpredictable, we planned general anesthesia. A  successful management of major abdominal surgery in such patients, with anesthetic challenges and implications  in these patients are reviewed in this case report

• 1.   Deshpande JP, Kale JH, Godbole MR, Phalke TL. Anesthetic management of an achondroplastic dwarf with difficult airway and kyphoscoliosis for total abdominal hysterectomy. Indian J ClinAnaesth 2021;8:475-478.
• 2.   A Jain, K Jain, JK Makkar& K Mangal. Case study: Anesthetic management of an achondroplastic dwarf undergoing radical nephrectomy. Southern African Journal of Anesthesia and Analgesia 2010;16:2, 77-79.
• 3.   Karnalkar AP, Deshpande A. Anesthesia management of patient with achondroplasia for abdominal hysterectomy. Int J Sci Rep 2015;1:264-6.
• 4.   NeisevilieNisa, Puneet Khanna, Dhruv Jain. Anesthetic Management of an Achondroplastic Dwarf with Difficult Airway and Spine for Total Hip Replacement: A Case Report. Gen Med (Los Angeles) 2016;4:227.
• 5.   TasnimN, Ghani M, Kumar S, Naeem S, Luqman S. Successful pregnancy and delivery in a women with achondroplasia. J Pak Med Assoc. 2021;71:146- 149.
• 6.   Tyagi A, Dass C, Rao NT, Soni KD. Emergency anesthetic management of an achondroplastic elderly gravida with polytrauma. Int J CritIlln Inj Sci. 2019;9:191-193

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