Anesthetic challenges in a long-standing giant syphilitic aneurysm involving the root, ascending aorta, and arch of aorta

Giant aortic aneurysms involving the aortic root, ascending aorta, and arch are rare, particularly those secondary to syphilis. We report a case of a long-standing giant syphilitic aortic aneurysm measuring 20 cm in a 41-year-old male presenting with progressive respiratory symptoms over 3 months. The case highlights significant anesthetic challenges, including airway compression, hemodynamic instability during induction, difficulty in ventilation due to chronic lung collapse, judicious initiation and weaning from cardiopulmonary bypass, and postoperative ventilatory management. This report underscores the importance of meticulous planning and alternative anesthetic strategies in managing giant thoracic aneurysms with mediastinal compression.