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Collaborative Establishment of Difficult Vascular Access for General Anesthetic Management of an Adult With Tetra-Amelia: A Case Report

Horn, Meghan P. MD*; Khaja, Minhaj S. MD; Stucken, Emily Z. MD; Saad, Wael E. MD

doi: 10.1213/XAA.0000000000000827
Case Reports

Tetra-amelia is a rare congenital disorder characterized by the absence of limbs. We describe the anesthetic management of a 29-year-old woman with tetra-amelia who underwent general anesthesia for tympanomastoidectomy with meatoplasty for an extensive right ear cholesteatoma. Anesthetic challenges related to tetra-amelia include difficult intravenous access, lack of sites for blood pressure monitoring, and possible difficult airway management due to craniofacial anomalies. Our case report focuses on the complex establishment of iliac artery access for invasive blood pressure monitoring by initially cannulating the carotid artery.

From the Departments of *Anesthesiology

Radiology, Michigan Medicine, Frankel Cardiovascular Center, Ann Arbor, Michigan

Department of Otolaryngology, Michigan Medicine, Ann Arbor, Michigan.

Accepted for publication May 14, 2018.

Funding: None.

The authors declare no conflicts of interest.

Address correspondence to Meghan P. Horn, MD, Department of Anesthesiology, Division of Cardiothoracic Surgery, 4172 Cardiovascular Center, 1500 E Medical Center Dr, SPC 5861, Ann Arbor, MI 48109. Address e-mail to

Copyright © 2018 International Anesthesia Research Society
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