Due to scarce data regarding “Middle Eastern Syndrome” or the Sanjad–Sakati syndrome, this case report aims to elaborate the significance of this rare autosomal recessive syndrome and the considerations to provide anesthesia to such patients. The patient discussed in this report is a diagnosed case of Sanjad– Sakati syndrome, indicated for surgical insertion of gastrostomy tube by laparotomy. The anesthetic concerns encountered included a difficult airway anatomy due to facial dysmorphic features and short stature, along with increased sensitivity to muscle relaxants. The case was further complicated by the presence of chest infection and electrolyte imbalance, particularly hypocalcemia, with the risk of seizures, cardiovascular collapse, and arrhythmias. A thorough preoperative assessment and multidisciplinary approach, including correction of electrolytes and optimization of the chest condition, followed by a cautious and vigilant intraoperative anesthetic management and close postoperative monitoring led to a smooth recovery and positive outcome with the avoidance of any morbidity or mortality.
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