Conclusion:
This case demonstrates successful intubation in a pediatric patient with
4QDS despite dysmorphic features and the potential for both laryngeal
narrowing and pain insensitivity associated with the patient’s genetic
condition. While this patient was not expected to be a difficult airway
upon preoperative physical examination, the dysmorphic facial features
were a cause of concern and extra care was taken in patient intubation.
In addition, a bilateral QL nerve block and adjunctive Tylenol,
constituting multimodal anesthesia technique, were utilized in our
patient for postoperative pain control. As demonstrated by this case,
successful intubation and the use of both general and regional
anesthesia can be safely accomplished in patients with 4QDS, though
sufficient caution should be taken when assessing and treating this
patient population. We suggest other patients with 4QDS be treated with
similar caution, given the potential for adverse events related to
inconsistently reported characteristics of this genetic syndrome.