Anaesthetic management of a case of down’s syndrome with Achalasia cardia

Achalasia cardia is a disorder of the gastrointestinal tract characterized by dilatation of the oesophagus and collection of food and fluids in the oesophagus leading to massive regurgitation and aspiration of gastric contents. Down’s syndrome has multisystem effects which can also present as difficult airway. Here, we present a case of a 14-year-old girl, a case of Down’s syndrome with Achalasia cardia and mitral valve prolapse posted for Heller’s cardiomyotomy. Anaesthetic concerns were difficult airway due to Downs’s syndrome, massive aspiration risks of Achalasia cardia and haemodynamic instability due to mitral regurgitation. In spite of proper preparation of the patient there was massive regurgitation of oesophageal contents during intubation which was managed successfully. Haemodynamic changes due to mitral valve prolapse also had to taken care of during the intraoperative period. Postoperative period was uneventful and the child was discharged after one week.