possibility of cardiac arrest, in addition to thermoregulation issues. 41 In particular, HSAN IV patients have absent or diminished autonomous protective airway reflexes that can increase the risk of regurgitation of gastric contents, leading to aspiration. 42 The current literature advocates for most surgical procedures to be performed in a hospital setting to most effectively manage these potential complications. As such, complex procedures should be conducted within a hospital. However, in our case, treatment in a hospital setting was challenging because of financial