Anesthesia management for patients with Prader-Willi syndrome undergoing bariatric surgery: a single-center retrospective case series study

Abstract

Background Prader-Willi syndrome (PWS) is a rare neurodevelopmental disease caused by abnormalities on chromosome 15q11.2-q13. Due to the characteristics of this syndrome, there are many difficulties in the anesthetic management of PWS patients undergoing bariatric surgery. Methods We reported five times anesthetic management in three patients with PWS undergoing bariatric surgery under general anesthesia combined with nerve block in the Third People’s Hospital of Chengdu. Results Obesity, sleep apnea, airway ventilatory dysfunction and hypotonia were the main challenge for patients with PWS in our study. We took some special measures, mainly including reverse Trendelenburg position, gradually deepening sedation, multimode analgesia and perioperative progressive respiratory exercise. Only in case1a, respiratory obstruction occurred during mask ventilation, which improved through the oropharynx and nasopharyngeal ventilation tract. In addition, delayed awakening occurred in case1a after surgery, and the respiratory condition did not improve significantly after the use of neostigmine and atropine. Her tracheal tube was removed on the first postoperative day. When she came in the second time (case1b), we used sugammadex as the antagonistic muscle relaxants and successfully removed the tracheal tube 10 minutes after the procedure. Conclusions We recommend choosing sugammadex as the antagonistic muscle relaxant, progressive respiratory exercise and multimode analgesia in PWS patients undergoing bariatric surgery. Besides, the oropharyngeal and nasopharyngeal ventilatory tract should be prepared before the anesthesia induction.