Airway management in Hurler's syndrome: A persistent challenge for anaesthesiologists.

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The difficulty in airway management of Hurler's syndrome or mucopolysaccharidosis (MPS) type I patients has been described as the worst.[1] These patients may develop serious complications under anaesthesia including airway obstruction leading to severe hypoxaemia, inability to ventilate or intubate and post-extubation problems.[2] Despite many potential benefits of using supraglottic devices for primary airway management in these patients over endotracheal tube (ETT) intubation, their usage has been limited. We at our centre decided to insert a Proseal laryngeal mask airway (PLMA) in awake state in a patient of Hurler syndrome to circumvent the problem of the difficult airway.