Anesthetic Management During Post-tonsillectomy Hemorrhage in a Child With Noonan Syndrome: A Case Report

TL;DR

This case report details the successful anesthetic management of a child with Noonan syndrome who experienced post-tonsillectomy hemorrhage.

Contribution

The report highlights a successful anesthetic approach for a complex pediatric case involving Noonan syndrome and post-tonsillectomy hemorrhage.

Findings

The patient did not experience hypoxemia or pulmonary aspiration during the emergent reintervention.

No blood transfusion was required despite the risks associated with Noonan syndrome and post-tonsillectomy hemorrhage.

Abstract

Noonan syndrome (NS) is an autosomal dominant congenital disorder characterized by short stature, facial dysmorphology, and congenital heart defects. It is associated with a bleeding diathesis and abnormal coagulation tests as well. Anesthetic management in these patients poses a multitude of challenges, including cardiovascular instability due to congenital heart diseases, hemorrhage caused by hemostatic disorders, and difficult airway management as a result of orofacial anomalies. In addition to this, post-tonsillectomy hemorrhage (PTH) is a potentially life-threatening complication.

In this case report, we describe a four-year-old patient with NS who underwent adenoidectomy and tonsillectomy due to sleep apnea-hypopnea syndrome (SAHS). He required emergent reintervention due to PTH. The patient did not suffer hypoxemia, pulmonary aspiration, nor did he require a blood transfusion. This case report pertains to the successful anesthetic management of a child with NS who suffered PTH. This troubleshooting situation is associated with several risks, such as difficult intubation, hypoxemia, hypotension, and pulmonary aspiration.

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