A cautionary tale of an emergency cerebrovascular procedure in the COVID-19 era

Area of Science:

• Anesthesiology
• Critical Care Medicine
• Neurology

Background:

• The COVID-19 pandemic significantly impacted healthcare system processes, particularly airway management.
• Stroke patients require urgent surgical intervention, such as carotid endarterectomy, for effective treatment.

Observation:

• A 37-year-old female stroke patient developed anaphylaxis upon extubation following a carotid endarterectomy.
• The anaphylactic reaction was attributed to sugammadex, a neuromuscular reversal agent.
• Institutional policies and resource limitations led to a delay in reintubation.

Findings:

• Despite the delay, the patient experienced no lasting neurological deficits.
• The case underscores the potential for existing healthcare policies to precipitate adverse events in critical care settings.
• Sugammadex-induced anaphylaxis can pose a significant challenge in emergency surgical scenarios.

Implications:

• There is a critical need to review and revise institutional policies to prevent delays in essential procedures like reintubation.
• Healthcare systems must adapt to manage rare but severe complications, such as sugammadex anaphylaxis, especially during public health crises.
• Improving airway management protocols and resource allocation is crucial for patient safety in neurovascular surgery.