Anesthetic Management in a Patient with Dandy-Walker Syndrome Undergoing Supraglottoplasty and Adenotonsillectomy: A Case Report

We report the case of a three-year-old girl with Dandy-Walker syndrome (DWS), severe obstructive sleep apnea (OSA), micrognathia, laryngomalacia, seizure disorder, and recurrent aspiration pneumonia who was scheduled for direct laryngotracheal bronchoscopy, supraglottoplasty, and adenoidotonsillectomy. Preoperative optimization included bronchodilator therapy and pulmonology input. Anesthetic management prioritized spontaneous ventilation using inhalational induction with sevoflurane followed by propofol infusion. Airway topicalization with lidocaine and adjunctive dexmedetomidine facilitated atraumatic airway manipulation. After endoscopic airway assessment, tracheal intubation was performed to complete the surgery. Given the extensive airway instrumentation and severe OSA, the patient remained intubated postoperatively and was extubated uneventfully in the pediatric intensive care unit after 24 hours. This case highlights the challenges of anesthetic management in children with complex syndromic airways and emphasizes the importance of strategies that maintain spontaneous ventilation, attenuate airway reflexes, and allow for safe postoperative monitoring.