{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T15:50:58Z","timestamp":1782489058364,"version":"3.54.5"},"reference-count":7,"publisher":"BMJ","issue":"4","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,1,22]]},"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:p>Wolf-Hirschhorn syndrome (WHS) is an uncommon genetic disorder that often presents with characteristic facial features, developmental delay and potential airway anomalies, which can complicate the anaesthetic management. We present a case of WHS in early childhood who came with severe upper airway obstruction due to grade 4 adenotonsillar hypertrophy and required an emergency tracheostomy. The situation was made even more challenging by craniofacial abnormalities, a submucosal cleft palate and a history of laryngomalacia. Anaesthesia was induced with inhalational sevoflurane and intravenous ketamine to preserve spontaneous ventilation. A multidisciplinary team approach, along with preparation for a difficult airway, ensured safe tracheostomy with minimal complications. This case highlights the importance of thorough preoperative assessment, preservation of spontaneous ventilation, preparedness for airway emergencies, with close communication with the surgical team during the perioperative period. It also emphasises the need for heightened vigilance in managing rare syndromes with potential multisystem involvement.<\/jats:p>","DOI":"10.1136\/bcr-2025-269586","type":"journal-article","created":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T15:10:19Z","timestamp":1775229019000},"page":"e269586","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Acute airway obstruction in a paediatric patient with Wolf-Hirschhorn syndrome requiring emergency tracheostomy"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-9879-2320","authenticated-orcid":false,"given":"Janani","family":"Kannan","sequence":"first","affiliation":[{"name":"Anaesthesiology & Critical Care, AIIMS Jodhpur, Jodhpur, Rajasthan, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harshada","family":"Sharma","sequence":"additional","affiliation":[{"name":"AIIMS Jodhpur, Jodhpur, Rajasthan, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8983-0953","authenticated-orcid":false,"given":"Shilpa","family":"Goyal","sequence":"additional","affiliation":[{"name":"Anaesthesiology & Critical Care, AIIMS Jodhpur, Jodhpur, Rajasthan, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,4,3]]},"reference":[{"key":"2026062608152432000_19.4.e269586.1","doi-asserted-by":"crossref","first-page":"485","DOI":"10.17219\/acem\/24111","article-title":"Wolf-Hirschhorn syndrome (WHS) - literature review on the features of the syndrome","volume":"23","author":"Paradowska-Stolarz","year":"2014","journal-title":"Adv Clin Exp Med"},{"key":"2026062608152432000_19.4.e269586.2","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1002\/ajmg.c.30187","article-title":"Update on the clinical features and natural history of Wolf\u2013Hirschhorn (4p\u2010) syndrome: Experience with 87 patients and recommendations for routine health supervision","volume":"148C","author":"Battaglia","year":"2008","journal-title":"American J of Med Genetics Pt C"},{"key":"2026062608152432000_19.4.e269586.3","doi-asserted-by":"crossref","first-page":"120","DOI":"10.17085\/apm.2020.15.1.120","article-title":"Anesthetic considerations for an adult with Wolf-Hirschhorn syndrome - A case report","volume":"15","author":"Kim","year":"2020","journal-title":"Anesth Pain Med (Seoul)"},{"key":"2026062608152432000_19.4.e269586.4","doi-asserted-by":"crossref","first-page":"231","DOI":"10.17245\/jdapm.2017.17.3.231","article-title":"Anesthetic considerations for a pediatric patient with Wolf-Hirschhorn syndrome: a case report","volume":"17","author":"Tsukamoto","year":"2017","journal-title":"J Dent Anesth Pain Med"},{"key":"2026062608152432000_19.4.e269586.5","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1111\/j.1365-2044.1988.tb09019.x","article-title":"Malignant hyperthermia in the Wolf-Hirschhorn syndrome","volume":"43","author":"Ginsburg","year":"1988","journal-title":"Anaesthesia"},{"key":"2026062608152432000_19.4.e269586.6","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1111\/j.1460-9592.2005.01419.x","article-title":"Anesthesia for children with Wolf-Hirshhorn syndrome: a report and literature review","volume":"15","author":"Mohiuddin","year":"2005","journal-title":"Paediatr Anaesth"},{"key":"2026062608152432000_19.4.e269586.7","doi-asserted-by":"crossref","DOI":"10.1111\/j.1460-9592.2004.01438.x","article-title":"Anesthesia for a child with Wolf-Hirshhorn syndrome","volume":"14","author":"Iacobucci","year":"2004","journal-title":"Paediatr Anaesth"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2025-269586","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T15:18:41Z","timestamp":1782487121000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2025-269586"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":7,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4,3]]},"published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1136\/bcr-2025-269586"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2025-269586","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]}}}