Anesthetic Μanagement of an Emergency Craniotomy in a Patient With Noonan Syndrome: A Case Report

A female patient with Noonan syndrome was evaluated for urgent surgical removal of an epidural hematoma, caused by a fall during a seizure attack. Preoperative evaluation revealed signs of a difficult airway, including abnormal craniofacial anatomy, short neck, and restricted neck mobility. In the operating room, endotracheal intubation with a McGrath MAC video-laryngoscope was attempted following the administration of 40 mcg dexmedetomidine (i.e., 1 mcg/kg infused in 10 minutes), 25 mcg fentanyl, and 1 mg midazolam. No desaturation or other adverse effects were recorded till the end of the procedure. This case report highlights critical anesthetic considerations of a patient with Noonan syndrome in the setting of a difficult airway, urgent surgical intervention, and limited patient cooperation. Airway manipulation of this surgical population necessitates careful preparation and planning. Anesthetic technique should be individualized according to the specific clinical manifestations of the syndrome.