Emergency surgery in a child with apert syndrome: the anesthetic challenges

Apert syndrome is an extremely rare congenital anomaly with acrocephalosyndactylia accompanying various other anatomical anomalies. This case report describes a 15 year old child with perforated appendix who presented for an emergency surgery. The Central Nervous System (CNS) and cervical spine anomalies in a child with Apert syndrome can give rise to unique anesthetic challenges. In an emergency scenario, other associated congenital anomalies need to be identified clinically and the anaesthetic plan needs to be modified accordingly.
Difficult intubation and bag mask ventilation needs to be anticipated and planned accordingly. Potential of tracheomalecia and bronchiectatic changes can give rise to ventilatory challenges in the intraoperative period. Opioids and other perioperative anaesthetic drugs can have a residual depressive impact on the CNS and lead to respiratory compromise. Awareness about the associated anomalies and preparedness for the known anesthetic challenges could minimize the risk to such patients.