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 cmH 2 O) 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 (SpO 2 80%), which was rapidly corrected with HFNO (50–70 L/min, FiO 2 60%–80%), restoring SpO 2 > 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.
Mincolelli et al. (Thu,) studied this question.