Three cases of suspected sugammadex-induced hypersensitivity reactions

Abstract

Neuromuscular blocking agents have been implicated in 60-70% of anaphylactic events associated with anaesthesia. We report two cases of probable hypersensitivity reaction to sugammadex and an additional suspected but less supported case of possible immune-mediated reaction or other adverse reaction. The patients were given a bolus of sugammadex 100 mg immediately before extubation. In all three patients, a possible allergic reaction was suspected within 4 min of sugammadex administration, but with different degrees of severity. Skin testing was positive in two of these patients. Hypersensitivity to sugammadex unaccompanied by cardiovascular or respiratory symptoms might be missed during the course of anaesthesia. Careful monitoring for possible allergic responses is required in patients who have received sugammadex.

Sugammadex as a reversal agent for neuromuscular block: an evidence-based review

“…This has been confirmed by several case reports of allergic reactions in patients who had received sugammadex for the first time 96–99. Reviews of both the published approval studies100 and of retrospective data from a single center in Japan over a period of 1 year97 show an incidence below 1%.…”

Association between sugammadex and anaphylaxis in pediatric patients: A nested case‐control study using a national inpatient database

“…Some reports described sugammadex‐induced anaphylactic reactions in adults . A previous study reported that incidence proportion of sugammadex‐induced anaphylactic reactions was estimated to be 0.003% .…”

Sugammadex: a turning point in our practice

“…The manufacturer recommends special caution using sugammadex in patients with highly depressed hepatic or renal function, infants, and in obstetric cases [5]. Hypersensitivity, which has caused a delay in FDA approval in the United States, is also a concern, as well as other adverse effects [6]. A randomized, safety assessor-blinded trial that included 128 Korean patients undergoing general anesthesia has been conducted.…”