This issue covers 3 interesting case reports. In the first case the authors highlight the issue of sedation during anaesthesia in a case of Mucopolysaccharidosis-IV. Patients with Mucopolysaccharidosis-IV may have craniofacial deformities and short neck, along with stiffening of the temporo-mandibular joints, anteriorly positioned larynx and an unstable atlanto-axial joint. All this poses difficulty in hyper-extension of the neck and resultant difficulty in intubation and laryngoscopy. The risk is compounded further in adults with Mucopolysaccharidosis-IV with deposition of glycosaminoglycans in the pharyngeal tissues.