Hutchinson-Gildford syndrome is an extremely rare condition characterized by the appearance of accelerated ageing. Reports of general anaesthesia in a child with progeria within the last 20 years in the English-spoken literature are very rare. We report a case of general anaesthesia in a 12-year-old boy with this condition. The child had a past history of failed intubation. Key points in the management of anaesthesia in progeria are discussed.

After sternotomy for coronary artery bypass grafting or valvular surgery, many patients experience significant post-sternotomy incisional pain, as well as pain from saphenous vein excision sites, and pericardiotomy and chest tube insertion points 1-5. Prevention and management of this pain continues to be a major challenge and under-treatment of pain postoperatively persists despite good surgical outcomes. Inadequate pain control after cardiac surgery results in increased morbidity, increased hospital length of stay and worsens patients' outcomes 3,5-7. Patients undergoing non-cardiac surgery often have a range of analgesic medications available to alleviate pain. However, in cardiac surgery, the efficacy of these drugs is tempered by side-effects that can interfere with the stability of the surgical intervention. Opioids, the cornerstone of postoperative pain control after cardiac surgery, have numerous deleterious side-effects as do nonsteroidal anti-inflammatory drugs; continuous local anaesthetic infusion may contribute to tissue necrosis and infection, and regional neuraxial anaesthesia is still controversial due to the anticoagulation received by this patient population 8-11. Acute postoperative pain is likely to have a neuropathic component, with numerous mechanisms that result in central and peripheral neural sensitisation. Gabapentin is an anti-epileptic drug that decreases neuropathic pain and the nociceptive processes by binding to the α 2 δ subunit of voltagedependent calcium channels 12. There are currently 26 randomised trials and a number of recent metaanalyses 12-17 that demonstrate the efficacy and safety of gabapentin for perioperative pain control. Gabapentin is safe in therapeutic doses with only minimal side-effects or drug interactions that would be concerning in cardiac surgery 12,13,18 , yet the efficacy of gabapentin in the treatment of postoperative