Anesthesia for an Infant with Pierre Robin Sequence and Pyloric Stenosis

Case: A six week old, full term male infant presents to the hospital with a history of several days of projectile, non-bilious vomiting. The child was diagnosed with Pierre Robin sequence shortly after birth based on severe micrognathia and associated large, midline cleft palate. He has required prone sleeping and feeding to maintain his airway but no invasive airway management. He has also a diagnosis of gastro-esophageal reflux but is otherwise healthy. Based on his presenting symptoms, abdominal ultrasound is performed which confirms pyloric stenosis and he was admitted for medical stabilization prior to surgical correction. A nasogastric tube and peripheral IV were placed. He has since been adequately fluid resuscitated and now has good urine output; electrolytes and vital signs are within normal limits.