title: [Anesthetic Management for Cervicomedullary Decompression in a Patient with Achondroplasia--A Case Report].
abstract: This is a case report of a 42-year-old man who underwent suboccipital craniectomy and C-1 laminoplasty under general anesthesia. His weight and height were 32 kg and 110 cm, respectively. The patient had short limbs, a protruding forehead, a large tongue, and a short neck. Preoperative magnetic resonance imaging showed marked stenosis of the foramen magnum and cervicomedullary compression and malacia, with the smallest anteroposterior diameter of 4.5 mm. Mask ventilation and tracheal intubation were not feasible; therefore, an Airtraq® laryngoscope and a bronchial fiberscope were used. Anesthesia was maintained with propofol, remifentanil, and fentanyl. After intubation and postural change, the patient was awakened, and we confirmed the absence of any limb movement disorder. Intraoperative motor evoked potentials were normal. After extubation, he experienced numbness of the limbs. Postoperative magnetic resonance imaging revealed an enlargement of the foramen magnum and the foramen of the atlas. However, the cervicomedullary malacia remained unchanged. The cause of numbness was unknown. After rehabilitation, he became ambulatory and could walk continuously for about 300 m at a slow pace.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Furuichi
authors.forename: Keiko
authors.initials: K
authors.lastname: Nakazato
authors.forename: Norihito
authors.initials: N
authors.lastname: Suzuki
authors.forename: Takashi
authors.initials: T
authors.lastname: Hongo
authors.forename: Atsuhiro
authors.initials: A
authors.lastname: Sakamoto
mesh_terms: D000130:Achondroplasia / Q000503:physiopathology / Q000601:surgery*; D000328:Adult; D000777:Anesthetics; D019299:Decompression, Surgical; D019054:Evoked Potentials, Motor; D005539:Foramen Magnum / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male
chemical_list: D000777:Anesthetics