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

Abstract

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.