Anesthetic challenges in a child with Lowe's & Fanconi syndr
Published in the Indian Journal of Anaesthesia, the authors report a case of a 2-year-old child scheduled for evaluation under anaesthesia following bilateral lens aspiration surgery.

KEY ISSUES: Anaesthetic management of patient with Lowe's syndrome for eye surgery is challenging due to associated problem of anticipated difficult airway, metabolic abnormalities, risk of convulsions, fragile bones, and need to prevent rise in intraocular pressure.

A 2-year-old child diagnosed with Lowe's syndrome presented with bilateral cataract since birth. He underwent bilateral lens aspiration surgery 2 months back, which was apparently uneventful but anaesthetic records were unavailable. There was no history of involuntary movements or seizures, but deep tendon reflexes were sluggish in all the four limbs.

The low haemoglobin was corrected by transfusing packed RBCs and oral iron supplementation. Additionally, the child was treated with potassium, magnesium, calcium, phosphate, and bicarbonate supplementation.

Inhalational induction using 8% sevoflurane with 100% oxygen was done and a 24 G intravenous cannula was secured on left dorsum of hand. Size 1.5 Ambu Aura 40 laryngeal mask airway was inserted and anaesthesia was maintained with sevoflurane 2–2.5% and 50% oxygen in air (1.0–1.2 minimum alveolar concentration) with pressure support ventilation (pressure support 10 cm of H2O and trigger of 1 l/min) using Drager Primus. 1% Dextrose in ringer lactate with total of 30 ml was given intraoperatively. The intraoperative course was uneventful.

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