Dang Son H, Samra Ara, Patel Bansi V, Sanchez-Luege Sebastian
Anesthesiology, Jackson South Medical Center - University of Miami Miller School of Medicine, Miami, USA.
Cureus. 2022 May 25;14(5):e25336. doi: 10.7759/cureus.25336. eCollection 2022 May.
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.
软骨发育不全患者常伴有解剖结构异常和心肺生理改变，这显著增加了他们围手术期发生心血管和呼吸并发症的风险（如通气/血流不匹配加重、即将出现的血氧饱和度下降、气道困难）。我们描述了一名34岁的软骨发育不全男性患者，因创伤性硬膜下血肿导致意识改变，需要紧急开颅血肿清除术。初次插管尝试因血氧饱和度迅速下降和心律失常而变得复杂。随后，患者发生心脏骤停，需要进行心肺复苏。成功置入喉罩气道（LMA）并相继完成纤维支气管镜插管。自主循环恢复（ROSC）后，重复CT扫描显示硬膜下血肿大小稳定，神经外科选择推迟手术，进行保守治疗和密切监测。该病例突出了软骨发育不全患者气道管理中独特的挑战和麻醉注意事项。
