Anesthesia Concerns for a Patient with Noonan Syndrome

A patient with Noonan syndrome may have a number of findings which must be taken into account during anesthesia and surgery.

Finding	Implication
difficult airway	preoperative assessment to identify problems prior to establishing an airway
congenital heart disease	cardiac monitoring and ventilatory support
coagulopathy	steps to control bleeding, especially in the postoperative period
orthopedic malformations	positioning and padding to minimize pressure points
intellectual impairment	procedural restraints, lack of cooperation

The difficult airway may be a result of:

(1) limited mouth opening

(2) cervical spine anomalies

(3) craniofacial anomalies and deformities

Congenital heart disease may involve:

(1) pulmonary valve stenosis

(2) hypertrophic obstructive cardiomyopathy

(3) ventricular septal defect (VSD)

(4) patent ductus arteriosus

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