4^th International Anesthesia and Pain Medicine Conference

Silver-Russell Syndrome (SRS) presents with intrauterine and post-natal growth failure, relative macrocephaly at birth and later protruding forehead and triangular facies, body asymmetry of varying degree, feeding difficulties and frequent episodes of hypoglycemia. SRS children present for surgeries related to male genital anomalies, orthopedic procedures or in extreme situations for feeding jejunostomies. Anesthetic challenges in such children are found mentioned in literature but have been sparingly reported. Laryngoscopy and intubation becomes difficult due to facial dimorphism because of micrognathia, down turned mouth (small mouth opening) and crowded upper dentition, high arched palate and sometimes subglottic stenosis. We report a case of 1.7-year-old child with typical features of SRS presenting with palpable undescended testes. Orchidopexy via inguinal approach was planned. Difficult airway was anticipated in view of protruding upper dentition, relatively small mouth opening and partial high arched palate. Control of airway was planned with supraglottic airway device. I-gel LMA was found far superior to Proseal LMA in achieving a good seal and airway patency in an asymmetric oropharynx due to a partial high arched palate. Hypoglycemia was prevented by restricting the fasting duration and close monitoring. Ilioinguinal nerve block lowered the anesthetic requirements intraoperatively.