Emergency Surgery in a Child with Cretinism with Anticipated Difficult Airway Under Low-Dose Subarachnoid Block

Area of Science:

• Pediatric Anesthesiology
• Pediatric Endocrinology

Background:

• Cretinism, a condition resulting from severe congenital hypothyroidism, presents significant anesthetic challenges in children.
• These challenges include intellectual disability, physical impairments, metabolic and physiological derangements, difficult airway management, and a predisposition to cardiorespiratory complications.
• Spinal anesthesia is known for providing excellent surgical anesthesia with remarkable cardiorespiratory stability in pediatric patients.

Observation:

• This report details the anesthetic management of a pediatric patient with previously undiagnosed cretinism.
• The anesthetic technique employed was subarachnoid block (spinal anesthesia).

Findings:

• The subarachnoid block provided successful and complete surgical anesthesia for the child.
• The anesthetic management was associated with remarkable cardiorespiratory stability throughout the perioperative period.
• This represents the first reported instance of successful anesthetic management using spinal anesthesia in an unevaluated child with cretinism.

Implications:

• This case highlights the potential utility and safety of spinal anesthesia in pediatric patients with cretinism, even when undiagnosed.
• It suggests that spinal anesthesia can be a viable option for managing anesthesia in these complex pediatric cases, mitigating risks associated with general anesthesia.
• Further research into anesthetic techniques for children with cretinism is warranted to optimize patient outcomes.