Anesthesia for bariatric surgery in an achondroplastic dwarf with morbid obesity.
OBJECTIVE
Achondroplasia is the most common form among the different types of osteochondrodysplasia that cause dwarfism. Dwarves develop obesity quite frequently and surgical treatment has shown greater efficacy, both for effective weight loss and long term maintenance. The objective of this report was to present the case of bariatric surgery with Y-en-Roux gastric bypass in an achondroplastic dwarf with morbid obesity. The different difficulties in the anesthetic management of this patient and the way they were dealt with were discussed in order to decrease intraoperative morbidity and mortality.


METHODS
This is a 29 years old female dwarf with achondroplasia and morbid obesity since childhood. She was 123 cm tall and weighed 144 kg at the time of admission to the Bariatric Surgery service. With a body mass index (BMI) of 95.18 kg.m2, she had several associated diseases especially of the respiratory system and osteoarticular system. After a long follow-up with diet, exercises, and psychological support, her clinical condition improved and she was referred for surgery: Y-en-Roux gastroplasty using the technique of Capella-Fobi. Intubation of the awake patient under direct laryngoscopy was difficult and a bronchofibroscope had to be used. Surgery was uneventful and the patient was maintained under total intravenous anesthesia with continuous infusion of remifentanil and propofol. She was extubated at the end of the surgery still in the operating room.


CONCLUSIONS
The simultaneous comorbidities of achondroplasia and morbid obesity can hinder the anesthetic management, especially regarding the airways. A thorough pre-anesthetic evaluation is necessary to anticipate the conducts and minimize risks, therefore optimizing the evolution of anesthesia.
CET/SBA Prof. Bento Gonçalves do Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro (HUCFF/UFRJ), RJ. m.angelica.a@globo.com
Maria Angélica
MA
Abrão
Vinícius Gomes
VG
da Silveira
Carlos Frederico Loretti Vaz
CF
de Almeida Barcellos
Roberta Costa Marques
RC
Cosenza
João Régis Ivar
JR
Carneiro
D000130:Achondroplasia / Q000150:complications*; D000328:Adult; D000758:Anesthesia; D050110:Bariatric Surgery; D005260:Female; D006801:Humans; D009767:Obesity, Morbid / Q000150:complications* / Q000601:surgery*