Anesth Pain Med.  2019 Jul;14(3):294-298. 10.17085/apm.2019.14.3.294.

A suspected sugammadex-induced anaphylactic shock: A case report

• Koo BS
• Lee SJ
• Na HW
• Kang WB
• Kim SH

• KMID: 2454814
• DOI: http://doi.org/10.17085/apm.2019.14.3.294

Abstract

BACKGROUND
The reversal of a neuromuscular blockade has typically been achieved with a cholinesterase inhibitor and the concomitant use of an anticholinergic agent, and this remains a popular method. Since the introduction of sugammadex in the market, its use has been increasing because of the rapid recovery from a neuromuscular blockade achieved by rocuronium. The occurrence of anaphylaxis or an anaphylactic reaction resulting from sugammadex is rare and has been reported sparsely. Thus, one may not recognize the possibility of sugammadex-induced hypersensitivity when sudden life-threatening hypotension occurs, especially without skin manifestations during the emergence of anesthesia. This may delay treatment and increase morbidity. CASE: We report a case of a sugammadex-related hypersensitivity reaction which manifested as pure cardiovascular collapse during the emergence of anesthesia.
CONCLUSIONS
We emphasize that vigilance should be paid for at least five minutes following sugammadex administration in daily clinical practice.

Keyword

Anaphylaxis; Hypersensitivity; Sugammadex

MeSH Terms

Anaphylaxis*
Anesthesia
Cholinesterases
Hypersensitivity
Hypotension
Methods
Neuromuscular Blockade
Skin Manifestations
Cholinesterases

Figure

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  Fig. 1 Skin tests for sugammadex and rocuronium. Histamine (1 mg/ ml) and saline were used as positive and negative controls, respectively (A). Skin prick test for sugammadex (1 : 1 solution) showed a positive result as the diameter of the wheal was over 3 mm, but a negative result for rocuronium (B). Intradermal skin test with dilutions of sugammadex (1 : 100, 1 : 1,000, and 1 : 10,000) showed positive results as the diameter of the wheal was over 8 mm (C).

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