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.
Keywords: Sturge–Weber syndrome; continuous positive airway pressure; high flow nasal oxygen; obesity hypoventilation syndrome; obstructive sleep apnea syndrome; perioperative management; sleep medicine.
Copyright © 2026 Giuseppe Mincolelli et al. Case Reports in Medicine published by John Wiley & Sons Ltd.