Anesthetic Management of Achondroplastic Dwarf with Difficult Airway for Renal Transplantation
Begüm Nemika Gökdemir, Nazrin Zulfugarlı, Nedim Çekmen, Adnan Torgay
Başkent Üniversitesi Ankara Hastanesi, Anesteziyoloji ve Reanimasyon Bilim Dalı
Giriş: Anesthetic management of achondroplastic patients warrants special anatomical and physiological considerations like accessing intravenous line, abnormality of skeletal, cardiopulmonary, central nervous system, craniofacial system, calculating drug doses and due to chondroplasic changes these patients have difficult airway and so its management is compelling for anesthesiologist.
Olgu: A 37-year-old male patient (31 kg, 123 cm) who has glomerulonefritis related ESRD was admitted for cadaveric RT. He had hemodialysis for 25 years. He was ASA III. His preoperative laboratory parameters, ECG and ECO were normal, but he has dyspnea. He had achondroplasia with dwarfism and cervical instability. His mallampati score was IV and Cormack-Lehane grade was III. Cervicothoracolumbar CT and MRI showed that he has significant thoracolumbar kyphoscoliosis, scattered focal emphysematous parenchyma areas in both lungs. We prepared difficult intubation cart which includes videolaringoscope, gum bougie, guide for ETT, different size of supraglottic airways and emergency cricothyrotomy set due to his airway difficulties. Oral and written consent was obtained from the patient. In OR, standard monitoring was instated. We inserted intravenous access after multiple attempts. Anesthesia induction was maintained with propofol, lidocaine, fentanyl, rocuronium. After preoxygenation, we hardly intubated him with 7.0 endotracheal tube using videolaringoscope at third time with cricoid pressure applied. Anesthesia maintenance was provided by infusion of remifentanil, rocuronium, inhaler sevoflurane, oxygen and air mixture. Since the incidence of pulmonary complications is high in achondroplasic patients, extubation was done with sugammadex and recruitment maneuver was performed in order to prevent postoperative atelectasis.
Tartışma ve Sonuç: In conclusion, achondroplasic patients with dwarfism are challenging patient group for anesthesiologists in terms of existing systemic deformities. We presented the case of cadaveric RT for achondroplasic patient with dwarfism and difficult airway. It should be kept in mind multidisciplinary approach and comprehensive preoperative preparation in anesthetic management of patient with difficult airway.
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