Review Article

Anesthetic Management in Mucopolysaccharidoses

Table 1

Classification of mucopolysaccharidoses.

TypeDenominationMain clinical featuresGAGS*Enzyme deficiency

MPS IHHurler syndromeSevere phenotype, macrocephaly, macroglossia, facial coarseness, hydrocephalus, mental retardation, joint stiffness, thoracic and lumbar kyphosis, possible odontoid hypoplasia.DS, HSα-L-Iduronidase

MPS ISScheie syndromeJoint stiffness, corneal turbidity, aortic valve disease, normal intellectual capabilities, macroglossia, normal stature, living until adulthood.DS, HSα-L-Iduronidase

MPS I H/SHurler-Scheie syndromeIntermediate phenotype, macrocephaly, macroglossia, joint limitations.DS, HSα-L-Iduronidase

MPS IIHunter SyndromeSevere course MPS I H-like, moderate course-clinical intermediate phenotype, late manifestations, living until adulthood with or without mental retardation.DS, HSIduronate-2-sulfatase

MPS III ASanfilippoA syndromeBehavior disorders, aggressiveness.HSHeparan-N-sulfatase

MPS III BSanfilippoB syndrome Progressive dementia, living until the second and third decade. HSα-N-acetyl-glucosaminidase

MPS III CSanfilippoC syndromeRemarkable interfamilial variability, mild dimorphism.HSAcetylCoA:a-glucosaminide
acetyltransferase

MPS III DSanfilippoD syndromeRough hair, limpid cornea, usually normal height.HSN-acetilglucosamine-6-solfatase

MPS IV AMorquioA syndromeShort trunk dwarfism, thin corneal opacities, skeletal dysplasia and spondylo epiphyseal, final height under 125 cm.KSN-acetilglucosamine-6-solfatase

MPS IV BMorquioB syndromeIdem MPS IV A, adulthood height under 120 cm.KSβ-galactosidase

MPS VIMaroteaux-Lamy syndromeHurler phenotype with pronounced corneal opacities and normal intellectual capabilities.DSN-acetylgalactosamine 4-sulfatase

MPS VIISly syndromeHigh phenotypic variability, dense granulocyte inclusions, macrocephaly, possible odontoid hypoplasia, shortness.CS, DS, HSβ-glucuronidase

DS: dermatan sulphate, HS: heparin sulphate, KS: keratin sulphate, and CH: chondroitin-6-sulphate.