Conclusion:
This case demonstrates successful intubation in a pediatric patient with 4QDS despite dysmorphic features and the potential for both laryngeal narrowing and pain insensitivity associated with the patient’s genetic condition. While this patient was not expected to be a difficult airway upon preoperative physical examination, the dysmorphic facial features were a cause of concern and extra care was taken in patient intubation. In addition, a bilateral QL nerve block and adjunctive Tylenol, constituting multimodal anesthesia technique, were utilized in our patient for postoperative pain control. As demonstrated by this case, successful intubation and the use of both general and regional anesthesia can be safely accomplished in patients with 4QDS, though sufficient caution should be taken when assessing and treating this patient population. We suggest other patients with 4QDS be treated with similar caution, given the potential for adverse events related to inconsistently reported characteristics of this genetic syndrome.