Achondroplasia is the commonest form of dwarfism and possesses multiple anesthetic challenges ranging from securing intravenous line, monitoring and calculating drug dosage to abnormalities of the airway, spine, thoracic cage, and obesity, cardiopulmonary and neurological system. Multiple case reports describing neuraxial anaesthesia, particularly in obstetrics patients are available but there are limited literature on airway management and general anaesthesia. We came across an achondroplastic dwarf for hip replacement with spine deformity where neuraxial anaesthesia was impossible and her difficult airway and chronic lung disease imposed serious anesthetic challenges. We describe the importance of awake fiberoptic intubation (FOI) for airway management and general anaesthesia in this patient with difficult airway and spine and restrictive lung disease for total hip replacement.

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A 15-year-old boy with neurofibromatosis type 1 (NF1) was referred to us for central venous catheter insertion, and on ultrasound of the neck, he was found to have extensive involvement of the brachial plexus due to the nerve sheath tumour. Multiple hypoechogenic lesions resembling the internal jugular vein and internal carotid artery were visualised and could be differentiated from the vessels by Doppler ultrasound. The importance of analyzing sonographic images of nerve sheath tumours, which can mimic blood vessels, and the importance of Doppler ultrasound for guiding central venous catheters in such patients to avoid nerve injury are discussed in this case report. Keywords: Neurofibromatosis, ultrasound, central venous cannulationNörofibromatoz tip 1 olan 15 yaşında bir erkek hasta santral venöz kateter takılması için bize yönlendirildi. Hastanın boyun ultrasonunda sinir kılıfı tümöründen dolayı yaygın brakiyal pleksus tutulumu izlendi. İnternal juguler ven ve internal karotis arteri anımsatan çoklu hipoekojen lezyonlar görüldü ve Doppler ultrason ile damarlardan ayırt edilebildi. Bu vaka sunumunda, kan damarlarını taklit edebilen sinir kılıfı tü-mörlerinin sonografik görüntülerinin önemi ve bu hastalarda sinir hasarlarından kaçınmak için santral venöz kateterlerine rehberlik etmesi açısından Doppler ultrasonun önemi tartışıl-maktadır.Anahtar Sözcükler: Nörofibromatoz, ultrason, santral venöz kanülasyon Abstract / Öz

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