A suspected case of sugammadex-induced anaphylactic shock -A case report-

Abstract

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.We describe a case involving a 69-year-old woman who developed anaphylatic shock caused by a clinical dose of sugammadex (2 mg/kg, 100 mg intravenously) 5 minutes after its administration. She developed redness and welts all over her body, and complained of an oropharyngeal itching sensation with dyspnea and dizziness. Her vital signs were closely monitored. She also experienced a sudden onset of hypotension (from 110/70 to 49/40 mmHg) and tachycardia (from 75 to 120 bpm). We diagnosed anaphylactic shock on the basis of these clinical manifestations. After 20 min of traditional treatment (hydration, ephedrine, cortisol, and phenylephrine), her vital signs returned to normal. No postoperative complications were evident, and the patient was discharged from the hospital. Although the prevalence of anaphylactic reactions to sugammadex is rare, physicians using sugammadex should be aware of the possibility of sugammadex-induced anaphylaxis. We report a case of suspected sugammadex-induced anaphylactic shock, the first in Korea. CASE REPORTThe patient was a 69-year-old woman (weight: 50 kg; Anesthesia was maintained with 2% sevoflurane and a 50% oxygen-nitrous oxide mixture. During the surgery, the bispectral index, oxygen saturation, and end-tidal CO2 were maintained within normal ranges. The BP was maintained between 170/100 and 90/40 mmHg, and HR between 65 and 90 bpm. The total operation time was 60 min. After checking that the

Anaphylactic shock after sugammadex administration, induced by formation of a sugammadex-rocuronium complex -a case report-

“…In the present case, phenylephrine was initially administered, before the usage of epinephrine. Although phenylephrine or ephedrine can be used in cases of anaphylactic shock [7], it was ineffective at an early point in the present case. Thus, we administered intravenous epinephrine and the patient recovered from anaphylactic shock.…”

Adverse events of sugammadex that occurred in a Korean population

“…The year or date of occurrence of adverse events was determined based on the publication year of the case reports, as exact years were not reported. There was one case in 2015, two cases in 2016, two cases in 2017, three cases in 2019, and two cases in 2020 ( Table 1 ) [ 3 - 12 ].…”

Estimated Incidence of Sugammadex-Induced Anaphylaxis Using the Korea Adverse Event Reporting System Database

“…One case report published in 2020 was submitted to a journal in 2019. Table 2 presents a summary of the reports on sugammadex-induced anaphylaxis [ 14 , 15 , 16 , 17 , 18 ]. None of the five patients had previously been exposed to sugammadex.…”

“…Since then, the incidence of sugammadex-induced anaphylaxis in a large-scale population has been reported for a few countries, but not for South Korea [ 6 , 10 , 11 , 12 ]. According to the pharmacopoeia of sugammadex (Bridion ® , MSD, Seoul, Korea) in South Korea, no anaphylactic reaction has been reported in a post-marketing survey of 718 patients [ 13 ], and only a few case reports have been published in South Korea [ 14 , 15 , 16 , 17 , 18 ]. Considering the trend of its rapidly increasing use for anesthesia, it is meaningful to investigate the incidence of sugammadex-induced anaphylaxis in a large-scale population.…”