Anaesthetic considerations in Shrinking Man syndrome: two case reports

Area of Science:

• Anesthesiology
• Nephrology
• Cardiology

Background:

• Shrinking Man syndrome (SMS) is a rare complication of dialysis-dependent end-stage renal disease.
• SMS presents with height loss, bone deformities, and cardiovascular damage, posing anesthetic challenges.
• Patients with SMS often exhibit abnormal facial changes and cardiovascular complications like hypertension and valvular heart disease.

Observation:

• Two cases of SMS with airway and cardiovascular alterations were treated at a tertiary care center.
• One patient had a predicted difficult airway and mitral stenosis; the other experienced significant hypotension.
• Diagnostic criteria included dialysis-dependent end-stage renal disease, height loss, and bone pain/deformity.

Findings:

• Anesthetic management involved awake fiberoptic bronchoscopy for tracheal intubation.
• Real-time transesophageal echocardiogram monitoring was utilized.
• Individualized blood pressure management strategies were implemented.

Implications:

• This case series emphasizes the critical need for thorough preoperative evaluation in SMS patients.
• Individualized anesthetic plans are essential for managing the complex airway and cardiovascular issues in SMS.
• Optimal anesthetic care can mitigate risks associated with SMS during medical procedures.