Perioperative Challenges in a Patient With Sturge-Weber and Obesity Hypoventilation Syndromes.

Abstract

Background: The rare concurrence of Sturge-Weber syndrome (SWS) and obesity hypoventilation syndrome (OHS) presents significant anesthetic challenges, with complexity in airway management and perioperative respiratory care.

Case presentation: A 55-year-old man with SWS and OHS underwent elective dental extraction. He was advised to undergo continuous positive airway pressure (CPAP) therapy (10 cmH₂O) preoperatively. Premedication included intramuscular clonidine (2 μg/kg). Awake fiberoptic intubation was performed under high-flow nasal oxygen (HFNO) support. Anesthesia was maintained with propofol and remifentanil via target-controlled infusion. In the PACU, CPAP intolerance led to desaturation (SpO₂ 80%), which was rapidly corrected with HFNO (50-70 L/min, FiO₂ 60%-80%), restoring SpO₂ > 94% within 3 min. The patient was discharged after 24 h of uneventful monitoring.

Conclusions: Awake fiberoptic intubation and the use of HFNO under strict ventilatory monitoring, as a rescue or bridging strategy, can facilitate safe anesthetic management in high-risk patients with SWS and OHS who are CPAP-intolerant. This case highlights the importance of multidisciplinary planning and individualized respiratory support strategies.