Tan Juan, Liu Haibei, Yang Huawu, Luo Dan, Fu Qiang, Li Qiang
Department of Anesthesiology, The Third People's Hospital of Chengdu, Qinglong Street 82, Chengdu, China.
Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China.
BMC Anesthesiol. 2025 Apr 17;25(1):188. doi: 10.1186/s12871-025-03013-1.
Prader-Willi syndrome (PWS) is a rare neurodevelopmental disorder resulting from abnormalities on chromosome 15q11.2-q13. These genetic anomalies pose significant challenges in anesthetic management when PWS patients undergo bariatric surgery.
We present five instances of anesthetic management in three PWS patients who underwent bariatric surgery under general anesthesia supplemented with nerve block techniques.
Obesity, sleep apnea, airway ventilatory dysfunction, and hypotonia were the primary challenges faced by PWS patients in our study. We implemented specific strategies, primarily including the reverse Trendelenburg position, gradually deepening sedation, multimodal analgesia and perioperative progressive respiratory exercises. Only in case 1a, respiratory obstruction occurred during mask ventilation, which was resolved through the use of a nasopharyngeal ventilation tract. Additionally, delayed awakening was observed in case 1a postoperatively, with the spontaneous breathing showing minimal recovery following the administration of neostigmine and atropine. Extubation of the tracheal tube was performed on the first postoperative day. Upon her second admission (case 1b), we administered sugammadex as the neuromuscular blockade reversal agent, which facilitated successful tracheal extubation ten minutes post-procedure.
We advocate the use of sugammadex as the neuromuscular blockade reversal agent, the implementation of neuromuscular monitoring, progressive respiratory exercises, and multimodal analgesia in PWS patients undergoing bariatric surgery.
普拉德-威利综合征（PWS）是一种罕见的神经发育障碍，由15号染色体q11.2-q13区域的异常引起。当PWS患者接受减重手术时，这些基因异常给麻醉管理带来了重大挑战。
我们介绍了3例接受减重手术的PWS患者在全身麻醉并辅以神经阻滞技术下的5次麻醉管理实例。
肥胖、睡眠呼吸暂停、气道通气功能障碍和肌张力减退是我们研究中PWS患者面临的主要挑战。我们实施了特定策略，主要包括头高足低位、逐渐加深镇静、多模式镇痛和围手术期渐进性呼吸锻炼。仅在病例1a中，面罩通气时出现了呼吸梗阻，通过使用鼻咽通气道得以解决。此外，病例1a术后观察到苏醒延迟，给予新斯的明和阿托品后自主呼吸恢复甚微。术后第一天进行了气管插管拔除。在她第二次入院时（病例1b），我们使用舒更葡糖作为神经肌肉阻滞逆转剂，术后10分钟成功实现了气管插管拔除。
我们主张在接受减重手术的PWS患者中使用舒更葡糖作为神经肌肉阻滞逆转剂，实施神经肌肉监测、渐进性呼吸锻炼和多模式镇痛。
