[Anesthetic management of a patient with tetra-amelia]

A 52-year-old man with Burger disease was admitted for hemorrhoidectomy. He lost upper and lower limbs 19 years earlier. We could not monitor his blood pressure with noninvasive technique. Bilateral superficial temporal arteries were not palpable. In the operating room, the external jugular vein was cannulated and an electrocardilgram and oxygen saturation was monitored. Anesthesia was induced with spinal anesthesia of 0.5% hyperbaric bupivacaine. His carotid artery was palpable and heart rate, oxygen saturation and his consciousness were stable during operation. He had an uneventful intra- and post-operative course. Preoperative evaluation of surgery and monitoring may be needed in patients with tetra-amelia.