Anesthetic concerns of achondroplastic patients with hip movement restriction scheduled for retrograde intrarenal surgery: A case report

Achondroplasia is an autosomal dominant inherited disorder that results in premature ossification of the epiphyseal growth plates and restriction of proximal long bone movement. Herein, we report the anesthetic management of such a patient undergoing stone retrieval in the lithotomy position. He had a restricted ability to flex and abduct the hip joint and lumbar hyperlordosis. These were anticipated to be a concern for the lithotomy position and prone to positional injuries. Hence, the decision was made to position the patient before induction of anesthesia in the presence of surgeons to ensure the optimal exposure needed for the procedure while avoiding any hyperflexion or abduction of the hip and knee joints. The position tolerated by the patient when awake and unsedated should be followed intraoperatively. Achondroplasia is also associated with difficult airway features, obesity, sleep apnea, and multisystem involvement. Careful preoperative evaluation and intraoperative vigilance are needed to manage these patients undergoing surgery.