Anesthetic management of a child with Russell-Silver syndrome

A 2-year-old boy with Russell-Silver syndrome (RSS) was scheduled for corrective surgery for hypospadia. He had characteristic features of RSS, such as intrauterine growth retardation with subsequent marked postnatal growth impairment, body asymmetry and small triangular face. Anesthesia was induced with sevoflurane in oxygen-enriched air. The lungs were easily ventilated with a bag and mask. Tracheal intubation was extremely difficult because of the micrognathia and high arched palate, but finally successful with the use of a stylet in the endotracheal tube. Caudal epidural block was not performed because of a possible spina bifida. There were no complications related to anesthesia and surgery.