Case Report Suspected Anaphylaxis After Administration of Sugammadex
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Anesthesia & Pain Research
Case Report: Suspected Anaphylaxis after Administration of Sugammadex
Osama Elsayed*
Correspondence:
*
Osama Elsayed, Anesthesia Specialist, Wrexham Maelor Hospital,
Anesthesia Specialist, Wrexham Maelor Hospital, UK. UK.
Received: 04 May 2024; Accepted: 01 Jun 2024; Published: 06 Jun 2024
Citation: Osama Elsayed. Case Report: Suspected Anaphylaxis after Administration of Sugammadex. Anesth Pain Res. 2024; 8(1): 1-2.
ABSTRACT
Anaphylaxis is a severe, life-threatening hypersensitivity reaction that can occur rapidly after exposure to an allergen.
Sugammadex is a novel neuromuscular blockade reversal agent used to counteract the effects of amino steroid muscle
relaxants such as rocuronium and vecuronium. Although generally considered safe, there have been rare reports of
anaphylaxis following sugammadex administration. This case report describes an incident of anaphylaxis triggered by
sugammadex, highlighting the clinical presentation, management, and potential implications for anesthesia practice.
Keywords followed by 100 mg rocuronium for muscle relaxation and
Allergy, Anaphylaxis, Sugammadex. intubation. Intubation was done uneventfully.
Introduction Intraoperative
Sugammadex is a cyclodextrin derivative that selectively binds to • Prophylactic Antibiotic was given (Gentamycin 240mg and
amino steroid neuromuscular blocking agents, rapidly reversing Metronidazole 500mg IV)
their effects. Its use has become increasingly common due to • Anaesthesia Was Maintained with TCI Propofol and
its efficacy and favourable safety profile. However, as with any Remifentanil.
pharmacological agent, adverse reactions can occur. Anaphylaxis • 10 mg morphine IV, parastomal 1 gm IV, and Ketorolac 30 mg
to sugammadex, although rare, is a serious concern due to its IV were given for pain.
sudden onset and potential severity. • The surgery proceeded uneventfully, and sugammadex (500
mg) was administered to reverse the neuromuscular blockade
Case Presentation at the end of the procedure.
Patient Profile • Reaction: Within 2minutes of sugammadex administration,
• Age: 48-year-old the patient developed massive bronchospasm (saturation
• Gender: Female dopped and airway pressure was very high), and severe
• Weight: 120 kg and BMI 45.2 hypotension (blood pressure dropped to 68/52 mmhg).
• Medical History: Known Catamenial Anaphylaxis, HTN,
Osteoarthritis, Fibromyalgia and vitamin B12 deficiency. Management: An anaphylactic reaction was immediately
• Allergic History: Penicillin and Plasters suspected. The patient was treated with:
• Surgical Procedure: Elective laparoscopic Bilateral Salpingo- • Ventilation was maintained positive bag mask ventilation.
oophorectomy • Intravenous epinephrine (initial bolus of 0.5mg)
• Fluid resuscitation with crystalloids
Clinical Course • Aminophylline 500mg IV with 100 ml Normal saline bag.
Preoperative: Patient was premedicated with midazolam. • Magnesium Sulphate 5 gm IV.
Anesthesia was induced with TCI propofol and Remifentanil, • Antihistamines (IV diphenhydramine)
Anesth Pain Res, 2024 Volume 8 | Issue 1 | 1 of 2
• Corticosteroids (IV hydrocortisone) such as fluids, antihistamines, and corticosteroids.
• Bronchodilators (nebulized Salbutamol) • Prevention and Preparedness: Anesthesia providers should
• The patient's symptoms improved with this treatment regimen. be prepared for anaphylactic emergencies, with protocols and
She was extubated and moved out of theatre to Recovery. She medications readily available.
was admitted in the intensive care unit (ICU) for 24 hours and
recovered without further complications. Conclusion
This case underscores the importance of awareness and
Discussion preparedness for rare but severe reactions like anaphylaxis
Anaphylaxis is a critical condition that requires prompt recognition following sugammadex administration. Although sugammadex is
and treatment. Sugammadex-induced anaphylaxis, although generally safe and effective, anesthesiologists and perioperative
uncommon, should be considered in the differential diagnosis teams must be equipped to recognize and manage anaphylactic
when a patient develops sudden hypersensitivity reactions in reactions swiftly to ensure patient safety.
the perioperative period. The pathophysiology is not entirely
understood but may involve direct histamine release or IgE- References
mediated mechanisms. 1. Naguib M, Brull SJ, Kopman AF. Sugammadex: A
revolutionary drug in neuromuscular pharmacology.
Key Points: Anesthesiology. 2017; 126: 417-435.
• Incidence: Reports suggest a low incidence of sugammadex-
induced anaphylaxis, but clinicians should remain vigilant. 2. Min KU, Park KH, Jang YJ. Anaphylaxis to sugammadex
• Recognition: Rapid identification of anaphylactic symptoms confirmed by skin prick testing. Korean Journal of
(cutaneous, cardiovascular, respiratory) is crucial. Anesthesiology. 2015; 68: 509-512.
• Management: Immediate administration of epinephrine is 3. McDonnell NJ, Paech MJ. Sugammadex and anaphylaxis:
the cornerstone of treatment, along with supportive measures An instant reaction. Anaesthesia. 2015; 70: 1390-1395.
© 2024 Osama Elsayed. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License
