Indian Journal of Clinical Anaesthesia 2023;10(3):318–321 Content available at: https://www.ipinnovative.com/open-access-journals Indian Journal of Clinical Anaesthesia Journal homepage: www.ijca.in Case Report A case report on anaesthetic challenges in Patau syndrome: Navigating craniofacial and cardiac defects Abha Singh 1 , Pragya Shukla 1, *, Amrita Rath 1 , Shashi Prakash 1 , Sanjay Bhaskar 1 1 Dept. of Anaesthesiology, Institute of Medical Sciences, BHU, Varanasi, Uttar Pradesh, India ARTICLE INFO Article history: Received 30-01-2023 Accepted 04-07-2023 Available online 07-09-2023 Keywords: Atrial septal defect Craniofacial defect Difficult airway Esophageal dilator Limited resources Patau syndrome ABSTRACT The anaesthetic management of paediatric patients with Patau syndrome presents unique challenges, particularly when combined with craniofacial and cardiac defects and limited airway resources. This case report highlights our experience in managing a syndromic child with a difficult airway in a resource- constrained environment. The inability to secure the airway adequately can pose significant perioperative risks. In this case, we successfully utilized an oesophageal bougie as an alternative technique to secure the airway. This report emphasizes the importance of adapting to limited resources and employing innovative approaches to ensure optimal patient care in challenging situations. This is an Open Access (OA) journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. For reprints contact: reprint@ipinnovative.com 1. Introduction Patau syndrome is the third most common autosomal trisomy disorder, after Trisomy 21 and Trisomy 18, with a prevalence rate of 8 to 15 per 100,000 live births. 1 Patau syndrome phenotype is characterized by multiple craniofacial and congenital organ malformations leading to difficult ventilation and intubation. 2 Cleft palate is reported in 75% of cases and is associated with increased risk of pulmonary aspiration and infection. 2 This risk further increases with age due to development of thoracic kyphoscoliosis resulting in reduced lung volumes and ineffective cough. 3,4 As the paediatric patients have poor functional residual capacity, unsuccessful intubation can lead to hypoxemia, bradycardia and even cardiac arrest. 5 The airway devices for difficult airway in paediatric patients are often restricted due to unavailability and smaller sizes, hence a well formulated strategies are often required. 5,6 * Corresponding author. E-mail address: drabhasingh1990@yahoo.in (P. Shukla). 2. Case Report A 2 years 6 months old male child weighing 8.5 kg, a known case of Patau syndrome (Trisomy 13) was planned to undergo laparoscopic orchiopexy surgery for bilateral non-palpable undescended testis. The physical examination revealed craniofacial anomalies like short-webbed neck, micrognathia, bulbous nose, prominent occiput, sharp canines, incisors tooth decay and limb defects like swollen palms and soles with clenched fingers and toes (Figures 1 and 2). The birth history suggested preterm assisted vaginal delivery at 36 weeks of gestational age, with 1.2 kg birth weight. Although baby cried immediately after birth but, was dyspnoeic and shifted to ventilator in Neonatal Intensive Care Unit for 2 weeks due to Respiratory distress syndrome (RDS). The boy had a history of weak cry with poor rooting, suckling reflexes, feeding difficulty, regurgitation of milk through the mouth and nose till the age of 2 years, without any obvious oropharyngeal deformity. The general examination revealed delayed developmental milestones, poor nutritional status, small scrotal sac, normal intelligence quotient (IQ) for age with https://doi.org/10.18231/j.ijca.2023.065 2394-4781/© 2023 Author(s), Published by Innovative Publication. 318