Cardiac arrest after sugammadex administration in a patient with variant angina: a case report

Abstract

A 76-year-old man with no notable medical history was scheduled for a robot-assisted radical prostatectomy. After the operation, he was given sugammadex. Two minutes later, ventricular premature contraction bigeminy began, followed by cardiac arrest. Cardiac arrest occurred three times and cardiopulmonary resuscitation was done. The patient recovered after the third cardiopulmonary resuscitation and was transferred to the intensive care unit. Coronary angiography was done on postoperative day 1. The patient was diagnosed with variant angina and discharged uneventfully on postoperative day 8.

A rare case of atropine-resistant bradycardia following sugammadex administration

“…Thus, echocardiography finding does not exclude a diagnosis of Kounis syndrome. A previous case report describing profound bradycardia with severe hypotension after sugammadex administration also mentions the simultaneous appearance of ST change on ECG [9]. This report confirmed coronary vasospasm provoked by ergonovine on coronary angiography postoperatively.…”

“…In this case, approximately 4 min after sugammadex administration, the patient's heart rate decreased to 36 bpm accompanied by severe hypotension, which was unresponsive to intravenous atropine but recovered with intravenous adrenaline. Some case reports have described severe bradycardia associated with sugammadex [4][5][6][7][8][9]. Sugammadex-induced bradycardia is not due to cholinergic effects as it has been noted even in a patient with a denervated, transplanted heart [8]; however, no other mechanism has been postulated.…”

“…However, the incidence of sugammadex-induced anaphylaxis is relatively high [3]. In addition, several case reports have described profound bradycardia, even cardiac arrest, possibly caused by sugammadex administration, although the mechanism of this rare adverse event has remained unclear [4][5][6][7][8][9].…”

Sudden Cardiac Collapse After Sugammadex Administration in a Patient with First Variant Angina Attack

“…14,15 There are only a few case presentations that show coronary vasospasm may be correlated with sugammadex. 16,17 The study, in which the hemodynamic effects of sugammadex and neostigmine on cardiac patients are compared, has found that sugammadex is more stable regarding cardiac function but causes a significant decrease in heart rate within the first minute after its administration. 3 So the effects of sugammadex on cardiovascular system are not very well-known.…”

Two Cardiac Arrests that Occurred after the Administration of Sugammadex: A Case of Kounis Syndrome

“…Although it is considered to be a safe and well-tolerated drug, concerns about the risk of drug-induced hypersensitivity reactions to sugammadex have emerged from case reports [3][4][5]. Among case reports about cardiac arrests that occurred after the administration of sugammadex, no cases of cardiac arrest related to Kounis syndrome induced by sugammadex have been reported [6,7].…”