TY - CHAP M1 - Book, Section TI - Disease States A1 - Gadsden, Jeff A1 - Jones, Dean L. PY - 2011 T2 - Anesthesiology Oral Board Flash Cards AB - Table Graphic Jump Location|Download (.pdf)|PrintConsiderationsMost common form of dwarfism (more than 100 other types). Autosomal dominant inheritanceAppearance: large head-to-body size difference, prominent forehead, shortened arms and legs, decreased muscle toneAirway management difficultiesCraniofacial and spinal abnormalities: limited neck extensionforamen magnum stenosislarge tonguelarge mandibleatlanto-axial instabilityKyphosis, scoliosis, and spinal stenosis: difficult and unpredictable spread of local anesthetics in epidural and subarachnoid spacesComorbidities: central and obstructive sleep apnea, otitis media (childhood), obesityHistoryPain/ataxia/incontinence/apnea—due to cervicomedullary/spinal cord compressionPhysical ExamNeurologic—hypotonia in infancyCraniofacial features—large head, midface hypoplasia, dental crowdingShort stature (normal trunk length)Bow legs (genu varum)Lab Tests/ImagingPolysomnography (assess CSA/OSA)Head/neck CT/MRI (assess craniocervical junction)ConsultsNeurology as indicated from history and examConflict(s)Endotracheal intubation and cervical instabilityCSA/OSA and use of sedatives/analgesicsRegional anesthesia and spinal/neurologic abnormalitiesOptimize/GoalsMinimize movement of cervical spine during ETT placement (consider referral to neurology if new onset/worsening symptoms)Consider adjuvants to opioids for pain management regarding OSAConsider imaging techniques before regional anesthesia to assess anatomy of vertebrae and spinal cord; also consider epidural versus spinal (titratable)OptionsGeneral anesthesia, regional anesthesia, or sedationPreop:PremedBlood: as indicated by surgical procedureICU/stepdown bed: consider severity of OSARoom Setup (Special Drugs/Monitors)Difficult airway cart availableBody size appropriate airways/laryngoscopesConsider use of alternative analgesics than opioids (dexmedetomidine, low-dose ketamine, regional)InductionIf GETA—consider AFOI as determined from airway/C-spine assessmentIf regional—use smaller doses of LA; beware high blockMaintenanceMaintain neck in neutral positionPositioning—consider patient’s body habitusEmergenceIf difficult intubation—consider leaving ETT in place or extubating fully awake, use of tube exchangerDisposition/PainRecovery/stepdown/ICU as required SN - 2161-5683 PB - The McGraw-Hill Companies CY - New York, NY Y2 - 2024/03/29 UR - accessanesthesiology.mhmedical.com/content.aspx?aid=55891073 ER -