Introduction And Importance: Perioperative anesthetic management in cases of severe airway obstruction with positional symptoms can be associated with difficulties in ventilation or intubation, with a risk of acute respiratory decompensation at every stage of anesthesia.
Case Presentation: Here we describe the anesthetic management of an 18-year-old woman with a mature teratoma who presented with progressive exertional dyspnea that was aggravated in the supine position in the operating room. After tracheal intubation, the tidal volume decreased, airway pressure increased, and pet CO2 grew beyond 105 mmHg without oxygen desaturation, prompting a femoro-femoral cardio-pulmonary bypass.