# Perioperative Challenges in a Patient With Sturge–Weber and Obesity Hypoventilation Syndromes

## TL;DR

A patient with rare Sturge-Weber and obesity hypoventilation syndromes required special anesthetic care, using techniques like awake intubation and high-flow oxygen to manage breathing risks.

## Contribution

This case study introduces a successful anesthetic strategy for patients with Sturge-Weber and obesity hypoventilation syndromes using awake fiberoptic intubation and high-flow nasal oxygen.

## Key findings

- Awake fiberoptic intubation and high-flow nasal oxygen effectively managed respiratory challenges in a CPAP-intolerant patient.
- Strict ventilatory monitoring and individualized strategies are crucial for high-risk patients with SWS and OHS.
- The patient was safely discharged after 24 hours of monitoring with no complications.

## Abstract

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.

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.

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.