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Anesth Analg 2006;103:1624
© 2006 International Anesthesia Research Society
doi: 10.1213/01.ane.0000246451.87630.d4

LETTER TO THE EDITOR

Editor-in-Chief Steven L. Shafer

Combined Spinal-Epidural Anesthesia for a Child with Freeman–Sheldon Syndrome with Difficult Airway

Mahesh Kumar Arora, MD, Gururaj Nagaraj, MD, and Sudershan T. Lakhe, MD

Department of Anaesthesiology and Intensive care; All India Institute of Medical Sciences; Ansari nagar; New Delhi, India; mkarora442{at}hotmail.com

To the Editor:

Freeman–Sheldon Syndrome (FSS) is an uncommon congenital anomaly associated with a difficult airway (1,2) and a predisposition toward malignant hyperthermia (3). We used a regional technique for the anesthetic management and postoperative analgesia in a child with FSS.

A 1.5-year-old male child, weighing 9.5 kg, with the diagnosis of FSS, was scheduled for correction of bilateral Congenital Talipes Equinovarus. Examination of the child’s airway revealed microstomia with mouth opening of 1 cm, micrognathia, small external nares, depressed nasal bridge, limited neck extension, normal dentition, and a relatively large head. We sedated the child with ketamine, followed by a propofol infusion. Surgical anesthesia was provided with a single intrathecal injection of 5 mg 0.5% bupivacaine in dextrose, followed by placing an epidural catheter into the caudal space, which was used to provide an additional 5 mL of 0.5% bupivacaine 50 min into the operation. The operation lasted 95 min. The catheter was maintained until the third postoperative day, and was used to provide analgesia by injections of 0.125% bupivacaine every 6 h.

REFERENCES

  1. Munro H, Butler P, Washington EJ. Freeman–Sheldon (whistling face) syndrome. Anaesthetic and airway management. Paediatr Anaesth 1997;7:345–8.[Web of Science][Medline]
  2. Cruickshanks GF, Brown S, Chitayat D. Anesthesia for Freeman–Sheldon syndrome using a laryngeal mask airway. Can J Anaesth 1999;46:783–7.[Web of Science][Medline]
  3. Jones R, Dolcourt JL. Muscle rigidity following halothane anesthesia in two patients with Freeman–Sheldon syndrome. Anesthesiology 1992;77:599, 600.




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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press