Perioperative Anesthetic Management for Bariatric Surgery in a Patient With Achondroplasia and Prior Limb-Lengthening: A Case Report.

Achondroplasia presents significant anesthetic challenges that may be amplified by morbid obesity. A 29-year-old woman with achondroplasia and morbid obesity (body mass index 69.0 kg/m²) underwent bariatric surgery after prior lower-limb lengthening of 17 cm. Despite her increased height, she retained achondroplasia-related torso proportions and airway features. Standard ramped positioning was ineffective because of her disproportionately short torso. High-flow nasal oxygen was used to maintain oxygenation during prolonged airway management. After failed intubation with a standard videolaryngoscope blade, the airway was secured using a hyperangulated X-blade. Quantitative neuromuscular monitoring and sugammadex facilitated safe extubation. This case suggests that increased height after limb lengthening should not be assumed to indicate lower upper-airway risk in patients with achondroplasia. Perioperative planning should emphasize body proportions rather than standing height, and high-flow nasal oxygen and hyperangulated videolaryngoscopy may be useful airway strategies.