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

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 lifethreatening 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.

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.…”