Anesthetic implications of protein C deficiency

We present an infant with congenital protein C deficiency who safely underwent three general endotracheal anesthetics without complication. Despite the real concerns of tissue damage, safe endotracheal intubation is possible. Anesthetic management should include preoperative protein C replacement, atraumatic technique, and, we believe, insurance of a sufficient air leak around the endotracheal tube. It may also be appropriate to consider alternatives to general anesthesia if surgical needs allow.