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

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Case Report

Volume 8, Number 12, December 2017, pages 388-392

Anesthetic Management of An Adolescent With Lowe Syndrome During Posterior Spinal Fusion

**Table 1.** Previous Reports of Anesthetic Care for Patients With Lowe Syndrome
Author and reference number	Patient demographics	Findings
Panday et al [6]	4-month-old, 5 kg boy scheduled for cataract surgery.	Preoperative electrolytes imbalances were corrected with potassium, calcium, magnesium, phosphate, and bicarbonate supplementation. Anesthetic induction with halothane, fentanyl and thiopental. Endotracheal intubation was difficult, accomplished on the fourth attempted with a Cormack-Lehane grade 3 view. Maintenance anesthesia with isoflurane, nitrous oxide fentanyl, and atracurium. No perioperative complications noted.
Saricaoglu et al [7]	7-year-old boy for bilateral tibial and femoral osteotomy.	Preoperative electrolytes imbalances were corrected with potassium, phosphate, and bicarbonate supplementation. Intravenous induction with propofol and vecuronium. Endotracheal intubation was via a guide wire because of limited neck extension. Maintenance anesthesia with desflurane and nitrous oxide. Intraoperative sodium bicarbonate administered for acidosis. No perioperative complications were noted.
Ramanathan et al [18]	3-year-old, 10 kg boy for bilateral cataract extraction.	Anesthetic induction with thiopentone and fentanyl. Neuromuscular blockade with atracurium. Maintenance anesthesia with halothane and nitrous oxide. No perioperative complications were noted. No perioperative complications were noted.
Komatsu et al [19]	7-month-old, 6.9 kg boy for cataract and glaucoma surgery.	Anesthetic induction and maintenance with sevoflurane in nitrous oxide.

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

Author and reference number

Patient demographics

Findings

Panday et al [6]

4-month-old, 5 kg boy scheduled for cataract surgery.

Preoperative electrolytes imbalances were corrected with potassium, calcium, magnesium, phosphate, and bicarbonate supplementation. Anesthetic induction with halothane, fentanyl and thiopental. Endotracheal intubation was difficult, accomplished on the fourth attempted with a Cormack-Lehane grade 3 view. Maintenance anesthesia with isoflurane, nitrous oxide fentanyl, and atracurium. No perioperative complications noted.

Saricaoglu et al [7]

7-year-old boy for bilateral tibial and femoral osteotomy.

Preoperative electrolytes imbalances were corrected with potassium, phosphate, and bicarbonate supplementation. Intravenous induction with propofol and vecuronium. Endotracheal intubation was via a guide wire because of limited neck extension. Maintenance anesthesia with desflurane and nitrous oxide. Intraoperative sodium bicarbonate administered for acidosis. No perioperative complications were noted.

Ramanathan et al [18]

3-year-old, 10 kg boy for bilateral cataract extraction.

Anesthetic induction with thiopentone and fentanyl. Neuromuscular blockade with atracurium. Maintenance anesthesia with halothane and nitrous oxide. No perioperative complications were noted. No perioperative complications were noted.

Komatsu et al [19]

7-month-old, 6.9 kg boy for cataract and glaucoma surgery.

Anesthetic induction and maintenance with sevoflurane in nitrous oxide.

**Table 2.** Perioperative Concerns of Lowe Syndrome
1. Difficult airway management
2. Proximal renal tubular dysfunction
a. metabolic acidosis
b. hypokalemia
c. hypocalcemia
d. hypophosphatemia
e. hypomagnesemia
f. hypercalciuria with stone formation
3. Renal insufficiency
4. Renal concentrating defect (isosthenuria)
5. Ocular involvement
a. cataracts
b. glaucoma
6. Central nervous system involvement
a. developmental delay
b. seizures
7. Bone fragility due to hypophosphatemic rickets
8. Hypoglycemia
9. Hypotonia
10. Platelet aggregation defect - generally of limited clinical significance

Table 2. Perioperative Concerns of Lowe Syndrome

1. Difficult airway management

2. Proximal renal tubular dysfunction

a. metabolic acidosis

b. hypokalemia

c. hypocalcemia

d. hypophosphatemia

e. hypomagnesemia

f. hypercalciuria with stone formation

3. Renal insufficiency

4. Renal concentrating defect (isosthenuria)

5. Ocular involvement

a. cataracts

b. glaucoma

6. Central nervous system involvement

a. developmental delay

b. seizures

7. Bone fragility due to hypophosphatemic rickets

8. Hypoglycemia

9. Hypotonia

10. Platelet aggregation defect - generally of limited clinical significance