Lodder–Merla Syndrome, a Multisystemic Disorder: Perioperative Anesthetic Management of an Infant

Objective. This paper aims to present the perioperative anesthetic challenges in an infant with Lodder–Merla syndrome. . We present a case report of a 7-month-old infant with Lodder–Merla syndrome, a pacemaker, epileptic spasms, and severe reflux, who was scheduled for open gastrostomy and gastrojejunal tube insertion. Such an intervention would constitute a second consecutive procedure under general anesthesia, shortly after pacemaker implantation. Perioperatively, emphasis was given to maintaining respiratory and cardiac stability, avoiding drugs with parasympathomimetic effects, preventing aspiration, optimizing ventilation, and controlling seizures. Conclusion. Since Lodder–Merla syndrome affects many organs, perioperative multidisciplinary collaboration and optimization of the affected systems are fundamental.