Managing Anesthesia in DEND Syndrome: A Delicate Balance

Abstract Developmental delay, epilepsy, and neonatal diabetes (DEND) syndrome is a rare and severe form of neonatal diabetes mellitus, with an incidence of <1 in 1000,000. Often misdiagnosed as type 1 diabetes mellitus, DEND syndrome should be suspected when diabetes is accompanied by neurological features. Here, we present the anesthetic management of a 10-year-old male with DEND syndrome scheduled for incision and drainage of a left submandibular abscess. The patient, diagnosed with DEND syndrome at 5 months of age, was initially treated with insulin and antiepileptic drugs, later transitioning to glibenclamide. Preoperative investigations revealed elevated C-reactive protein, fasting blood sugar, and glycated hemoglobin levels. The anesthetic plan included general anesthesia with nasal intubation under videolaryngoscopic guidance. Intraoperative management focused on maintaining stable glucose levels and vital signs, with successful extubation and uneventful recovery.