Anesthetic management of a child with Noonan's syndrome and idiopathic hypertrophic subaortic stenosis

Anaesthesia for emergency ventriculo-peritoneal shunt in an adolescent with Noonan's syndrome

A 15-year-old boy with Noonan's syndrome was admitted for emergency ventriculo-peritoneal shunt. Intraoperative course was complicated by hypertensive urgency, which was effectively managed with high doses of esmolol (500 μg/kg/min). Difficult airway was anticipated due to presence of webbed neck and facial dysmorphism. Tracheal intubation was however successfully accomplished with the aid of a bougie. This report thus highlights the unique anaesthetic problems encountered during anaesthetic management of such a case, which is worth sharing.

Anesthetic considerations and difficult airway management in a case of Noonan syndrome

Noonan syndrome is a genetically transmitted autosomal dominant disorder characterized by various anatomic anomalies and pathophysiologic derangements. Anesthetic management in such cases poses a multitude of challenges, especially related to the airway management and maintenance of cardiovascular stability. We report a case of a 9-year-old male child weighing 24 kg, who was diagnosed as a case of Noonan syndrome and had undergone ligation of patent ductus arteriosus during early childhood. The child was operated on for release of bilateral neck bands under general anesthesia. The case report pertains to the successful airway and anesthetic management in the background of difficult airway and existence of various cardiac lesions.