Anesthetic management in a patient with Marsili syndrome: A case report and review of literature

Introduction Marsili syndrome is a rare congenital disorder characterized by markedly reduced pain perception with preserved tactile and proprioceptive functions. Altered nociception presents unique challenges for anesthetic management, particularly regarding analgesic dosing and intraoperative monitoring. Case Presentation A 17-year-old male with Marsili syndrome underwent surgical debridement of an infected leg prosthesis. Preoperative assessment revealed diminished pain and temperature sensation, lip atrophy, and a potentially difficult airway. General anesthesia was induced and maintained with propofol and remifentanil, guided by bispectral index (BIS) monitoring. The intraoperative course was uneventful, with stable hemodynamic parameters; no postoperative analgesia was required. Conclusion This case demonstrates that safe anesthetic management in patients with Marsili syndrome can be achieved through individualized, carefully titrated anesthetic techniques and vigilant monitoring. Further clinical experience is required to establish standardized anesthetic guidelines for this rare condition.