J Med Cases

Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Med Cases and Elmer Press Inc

Journal website http://www.journalmc.org

Case Report

Volume 8, Number 10, October 2017, pages 330-333

Perioperative Care of a Pediatric Patient With Cockayne Syndrome

**Table 1.** Summary of Previous Reports of Anesthetic Care for Patients With Cockayne Syndrome
Author and reference	Patient demographics	Outcome and anesthetic care
DL: direct laryngoscopy; ETT: endotracheal tube; RSI: rapid sequence intubation; LMA: laryngeal mask airway; FOB: fiberoptic bronchoscope.
Cook [11]	A 9-year-old girl for dental surgery (extractions)	Inhalation induction with halothane. Bag-mask ventilation was difficult with upper airway obstruction. DL was difficult with visualization of the posterior aspect of the cords and arytenoids. ETT passed on third attempt after the administration of succinylcholine. Cricoid narrowing was noted as 5.0 and 4.5 mm ETTs could not be passed so a 3.5 mm ETT was used. No postoperative issues.
O’Brien and Ginserg [12]	A 4-year-old girl for extraction f left lamellar cataract	Inhalation induction with halothane. DL was difficult with narrow and highly arched palate, stiff epiglottis, and immobile larynx. A 3.5 mm ETT was successfully placed. No postoperative issues.
Wooldridge et al [13, 14]	A 19-year-old male for Nissen fundoplication and gastrostomy	RSI with thiopentone and succinylcholine. DL was difficult with only tip of epiglottis visible. Several failed attempts at “blind” oral intubation using 5 mm ETT. Bag-mask ventilation was difficult even with an oral airway. LMA was inserted and a guidewire placed using FOB as a conduit for the ETT. Neuromuscular blockade maintained with a second dose of succinylcholine. No postoperative issues.
	A 2-month-old girl for bilateral lensectomies	Inhalation induction with halothane. Oral airway insertion improved bag-mask ventilation. An LMA was easily inserted with improved air exchange. On second attempt, the epiglottis was visible with a Cormack and Lehane grade III-IV view. A 2.5 mm ETT was passed behind the epiglottis “blindly”.
	An 11-month-old boy for bilateral lensectomies	Inhalation induction with halothane. Larynx assessed as Cormack and Lehane grade III. A 4.0 mm ETT was passed on the first attempt “blindly” behind the epiglottis. No postoperative issues.
Yuen et al [15]	A 9-year-old girl for dental restorations	Intravenous induction with fentanyl and propofol. Easy bag-mask ventilation. A 4.5 mm ETT was placed without issues. At the completion of the case, prolonged emergence was noted. Hypertension (199/97 mm Hg) with ST depression noted.
Shimzu et al [16]	A 6-year-old girl for liver biopsy	Inhalation induction using sevoflurane. No problems with endotracheal intubation. No postoperative issues.
Rawlinson and Webster [17]	An 18-year-old female undergoing cesarean section	Spinal anesthesia with bupivacaine injected into subarachnoid space.
Raghavendran et al [18]	A 15-year-old girl for excision of posterior capsular membrane	Inhalation induction using sevoflurane. Mask ventilation straight forward. DL revealed grade 2 view of the glottis. A 4.0 mm ETT was placed. No postoperative issues.
Gaddam et al [19]	A 14-year-old male for dental restoration	Limited information regarding anesthetic care.
Tsukamoto et al [20]	A 17-year-old girl for dental treatment	Inhalation induction using sevoflurane. Easy bag-mask ventilation. A 5.0 mm ETT was successfully placed on the first attempt.

Table 1. Summary of Previous Reports of Anesthetic Care for Patients With Cockayne Syndrome

Author and reference

Patient demographics

Outcome and anesthetic care

DL: direct laryngoscopy; ETT: endotracheal tube; RSI: rapid sequence intubation; LMA: laryngeal mask airway; FOB: fiberoptic bronchoscope.

Cook [11]

A 9-year-old girl for dental surgery (extractions)

Inhalation induction with halothane. Bag-mask ventilation was difficult with upper airway obstruction. DL was difficult with visualization of the posterior aspect of the cords and arytenoids. ETT passed on third attempt after the administration of succinylcholine. Cricoid narrowing was noted as 5.0 and 4.5 mm ETTs could not be passed so a 3.5 mm ETT was used. No postoperative issues.

O’Brien and Ginserg [12]

A 4-year-old girl for extraction f left lamellar cataract

Inhalation induction with halothane. DL was difficult with narrow and highly arched palate, stiff epiglottis, and immobile larynx. A 3.5 mm ETT was successfully placed. No postoperative issues.

Wooldridge et al [13, 14]

A 19-year-old male for Nissen fundoplication and gastrostomy

RSI with thiopentone and succinylcholine. DL was difficult with only tip of epiglottis visible. Several failed attempts at “blind” oral intubation using 5 mm ETT. Bag-mask ventilation was difficult even with an oral airway. LMA was inserted and a guidewire placed using FOB as a conduit for the ETT. Neuromuscular blockade maintained with a second dose of succinylcholine. No postoperative issues.

A 2-month-old girl for bilateral lensectomies

Inhalation induction with halothane. Oral airway insertion improved bag-mask ventilation. An LMA was easily inserted with improved air exchange. On second attempt, the epiglottis was visible with a Cormack and Lehane grade III-IV view. A 2.5 mm ETT was passed behind the epiglottis “blindly”.

An 11-month-old boy for bilateral lensectomies

Inhalation induction with halothane. Larynx assessed as Cormack and Lehane grade III. A 4.0 mm ETT was passed on the first attempt “blindly” behind the epiglottis. No postoperative issues.

Yuen et al [15]

A 9-year-old girl for dental restorations

Intravenous induction with fentanyl and propofol. Easy bag-mask ventilation. A 4.5 mm ETT was placed without issues. At the completion of the case, prolonged emergence was noted. Hypertension (199/97 mm Hg) with ST depression noted.

Shimzu et al [16]

A 6-year-old girl for liver biopsy

Inhalation induction using sevoflurane. No problems with endotracheal intubation. No postoperative issues.

Rawlinson and Webster [17]

An 18-year-old female undergoing cesarean section

Spinal anesthesia with bupivacaine injected into subarachnoid space.

Raghavendran et al [18]

A 15-year-old girl for excision of posterior capsular membrane

Inhalation induction using sevoflurane. Mask ventilation straight forward. DL revealed grade 2 view of the glottis. A 4.0 mm ETT was placed. No postoperative issues.

Gaddam et al [19]

A 14-year-old male for dental restoration

Limited information regarding anesthetic care.

Tsukamoto et al [20]

A 17-year-old girl for dental treatment

Inhalation induction using sevoflurane. Easy bag-mask ventilation. A 5.0 mm ETT was successfully placed on the first attempt.