Anesthetic Management During Post-tonsillectomy Hemorrhage in a Child With Noonan Syndrome: A Case Report

Noonan syndrome (NS) is an autosomal dominant congenital disorder characterized by short stature, facial dysmorphology, and congenital heart defects. It is associated with a bleeding diathesis and abnormal coagulation tests as well. Anesthetic management in these patients poses a multitude of challenges, including cardiovascular instability due to congenital heart diseases, hemorrhage caused by hemostatic disorders, and difficult airway management as a result of orofacial anomalies. In addition to this, post-tonsillectomy hemorrhage (PTH) is a potentially life-threatening complication. In this case report, we describe a four-year-old patient with NS who underwent adenoidectomy and tonsillectomy due to sleep apnea-hypopnea syndrome (SAHS). He required emergent reintervention due to PTH. The patient did not suffer hypoxemia, pulmonary aspiration, nor did he require a blood transfusion. This case report pertains to the successful anesthetic management of a child with NS who suffered PTH. This troubleshooting situation is associated with several risks, such as difficult intubation, hypoxemia, hypotension, and pulmonary aspiration.