Severe bronchospasm after extubation in a post-covid-19 patient: therapeutic approach and case report.

Abstract

Introduction: Intraoperative bronchospasm is a life-threatening complication. This case is relevant to the medical literature, as it highlights post-COVID-19 laryngotracheobronchitis syndrome as a critical risk factor for airway hyperreactivity during extubation, an association still under investigation. Case presentation: A 66-year-old man was scheduled for wide local resection with skin grafting of the anterior chest. During the pre-anesthetic evaluation, the patient omitted a history of laryngotracheobronchitis following COVID-19 infection. Induction and maintenance were uneventful; however, immediately after tracheal extubation, he experienced severe bronchospasm, respiratory failure, and desaturation. Point-of-care ultrasound (POCUS) confirmed air trapping. Pharmacological management included IV adrenaline, magnesium sulfate, ketamine, steroids, and salbutamol, achieving stabilization and transfer to the inpatient ward. Conclusion: It is imperative that the pre-anesthetic evaluation thoroughly inquire about respiratory compromise and chronic complications arising from COVID-19. Identifying sequelae such as laryngotracheobronchitis allows for anticipating a hyperreactive airway and planning prophylactic strategies to avoid critical adverse events during emergency.