Anaesthetic Challenges and Management Strategies for Cystourethroscopy with Retrograde Pyelography and Left Ureteroscopic Surgery in a Patient with Kyphoscoliosis and a History of Operated Cystic Hygroma: A Case Report

Scoliosis is an idiopathic condition that predominantly affects females, with a ratio of 4:1, and an incidence ranging from 0.3-15%. Kyphoscoliosis, which involves both forward and lateral bending of the thoracolumbar spine, commonly results from idiopathic causes (70% of cases), with secondary causes including neuromuscular, congenital, or traumatic factors. The clinical significance of kyphoscoliosis lies in its potential to compromise respiratory mechanics and alter anatomical landmarks, posing challenges in perioperative and anaesthetic management. Addressing these challenges becomes more crucial when kyphoscoliosis is associated with other congenital anomalies, such as Cystic Hygroma (CH). CH is a common benign lymphatic cyst found in paediatric patients. Even after surgical intervention, CH can leave residual anatomical and physiological alterations that persist into adulthood, which may present anaesthetic challenges, including respiratory obstruction and the need to rule out additional congenital syndromes that necessitate comprehensive preoperative evaluation. This case report presents the anaesthetic challenges and perioperative considerations in a 18-year-old female with a history of operated CH and multiple congenital anomalies who is undergoing urological surgery. The presence of spinal deformity, restrictive lung disease, cardiac irregularities and prior surgical interventions necessitated a carefully tailored anaesthetic plan based on a multidisciplinary approach. The co-occurrence of congenital lymphatic and skeletal anomalies in this patient highlights the need for a multidisciplinary strategy, careful airway assessment and individualised anaesthetic planning to ensure optimal perioperative outcomes. This discussion explores the anaesthetic challenges and perioperative management in a case involving a child who underwent CH surgery, subsequently developed scoliosis in adulthood, and is now scheduled for cystourethroscopy with retrograde pyelography and left Ureteroscopic Surgery (URS).