Anaesthetic Considerations in an Achondroplastic Child with Thermal Burns: A Case Report

Achondroplasia is the most common cause of disproportionate dwarfism and is associated with multiple systemic abnormalities that pose unique challenges to anaesthetic management. Characteristic features such as hypotonia, delayed motor development and obesity often complicate perioperative care. Craniofacial anomalies, including midface hypoplasia, macrocephaly and craniocervical junction compression, increase the likelihood of a difficult airway. Additionally, skeletal deformities such as thoracolumbar kyphosis, spinal canal stenosis and abnormal vertebral anatomy make neuraxial anaesthesia technically challenging. Fluid and electrolyte imbalances, hypovolemia and altered pharmacokinetics further complicate drug dosing and anaesthetic selection. Present case is of a 13-year-old child with achondroplasia who sustained extensive thermal burns following accidental kerosene exposure and subsequently required split-thickness skin grafting under general anaesthesia. This case highlights the importance of anticipating anaesthetic complications in patients with achondroplasia and burns and of adopting an individualised, multidisciplinary approach to ensure safe outcomes. Ultrasound guidance was used to facilitate intravenous access. The anticipated difficult airway was managed with video laryngoscopy to minimise cervical spine movement. Muscle relaxation was achieved with rocuronium and reversed with sugammadex. The intraoperative course was uneventful and the patient was discharged the following day.