Multiple Anesthetics for Proton-Radiotherapy in a Child with Costello Syndrome

Costello syndrome (CS) is a rare genetic disorder caused by heterozygous germline Harvey rat sarcoma viral oncogene homolog (HRAS) gene mutations, and characterized by multi-system organ abnormalities. Associated craniofacial, cardiac, neurologic and musculoskeletal abnormalities may pose speci ic anesthetic challenges. Careful pre-anesthetic evaluation and planning is therefore essential to ensuring the safe delivery of care. In this case report, total intravenous anesthesia (TIVA) with propofol and spontaneous ventilation was successfully used to facilitate 28 proton-radiotherapy treatments in a child with Costello syndrome. TIVA with LMA was also successfully used during anesthesia for MRI of the pelvis.