Anesthetic Management of Asymptomatic Innominate Artery Compression Syndrome in an Elderly Patient Using Near-Infrared Spectroscopy and Bilateral Radial Arterial Pressure Monitoring

Innominate artery compression syndrome (IACS) is rare in adults and poses anesthetic challenges, as airway manipulation may exacerbate tracheal compression or compromise cerebral perfusion. Peri-intubation cerebral oxygenation in this context has rarely been reported. We describe the case of an 82-year-old woman with incidentally detected, asymptomatic IACS and moderate tracheal stenosis who underwent robot-assisted rectal surgery under general anesthesia. During fiberoptic-guided tracheal intubation, bilateral radial arterial pressures and near-infrared spectroscopy (NIRS) were continuously monitored to assess vascular and cerebral perfusion. No decline in regional cerebral oxygen saturation (rSO2) or increase in bilateral arterial pressure gradient was observed, and ventilation remained stable, including during steep Trendelenburg positioning. Careful anesthetic planning, with continuous monitoring of cerebral oxygenation and bilateral arterial pressures, may facilitate safe perioperative management in adults with this syndrome.