Caring for technology-dependent adolescents and young adults presents significant challenges, especially for procedural and peri-operative care. This review delves into the complexities of managing these patients before, during, and after major medical procedures or operations, highlighting the unique medical and psychosocial issues that demand specialized attention. We address the intricacies of pre-procedural assessment and optimization, as well as post-procedural management, with a particular focus on the challenges associated with life-sustaining technologies such as chronic ventilator dependence. Additionally, we explore medicolegal factors such as guardianship and surrogate decision-making, which are often more complex in this population. The review also identifies key areas of uncertainty that merit further research and exploration, aiming to enhance the quality of care and improve outcomes for technology-dependent individuals transitioning to adult healthcare.