Three suspected cases of sugammadex-induced anaphylactic shock

Takazawa, Tomonori; Tomita, Yukinari; Yoshida, Nagahide; Tomioka, Akihiro; Horiuchi, Tatsuo; Nagata, Chie; Orihara, Masaki; Yamada, Makiko; Saito, Shigeru

doi:10.1186/1471-2253-14-92

Cited by 59 publications

(47 citation statements)

References 17 publications

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“…Their and our similar results support that sugammadex gives similar muscle responses in trachea and bronchus. In addition, laryngospasm ,bronchospasm and anaphylaxis related sugammadex were reported in a few clinical data [16][17][18][19][20][21][22][23][24][25][26][27]. Absence of tracheal tissue response in our study suggests that these clinical conditions related with other mechanisms except the tracheal tissue response.…”

Section: Discussionsupporting

confidence: 51%

Effect of sugammadex and neostigmine on tracheal muscle: In vitro study

Erel¹

2018

Ann Clin Anal Med

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Aim: There are limited numbers of in vitro organ studies both neostigmine and, sugammadex. Up to date, we can reach no study in the literature comparing advantages and disadvantages of two agents in vitro. The study, we aimed to compare and demonstrate in vitro effects of neostigmine and sugammadex in rat trachea with basal and supramaximal tonus. Material and Method: A total of 24 adult male rats were divided into four groups: Group 1; Basal tonus+sugammadex, Group 2; Supramaximal contraction+sugammadex, Group 3; Basal tonus + neostigmine, Group 4; Supramaximal contraction+neostigmine.After anesthesia, trachea of each rats were removed and suspended in Krebs solution. After the vitality of the tissues was shown with acetylcholine and atropine, sugammadex was applied to group 1 and neostigmine to group 3 all in basal tonus. In other two groups, after supramaximal tonus with acetylcholine, sugammadex was applied to group 2, neostigmine to group 4. The contraction responses of each group were compared. Results: There was no significant change in comparison of the sugammadex groups (p>0.05). On the other hand, neostigmine increased tracheal tonus both in the basal tonus group (mean 25-40% ± 3.54), (p <0.05) and supramaximal tonus group (mean 15% ± 2.8) and were statistically significant (p <0.05). Discussion: In our study, neostigmine increased tracheal tone in both basal and supramaximal contractions. Neostigmine use, which may increase the risk of tracheal contractility, can be risky for surgical procedures. Therefore sugammadex may be preferred as there is no effect on tracheal tissue.

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Section: Discussionsupporting

confidence: 51%

Effect of sugammadex and neostigmine on tracheal muscle: In vitro study

Erel¹

2018

Ann Clin Anal Med

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“…Additionally, β-CDs have proven to be very useful in therapy as they have not shown any hypersensitivity reaction, unlike Sugammadex. This modified γCD used in anesthesia to reverse the effect of neurovascular blocking drugs has been involved in allergic response in some patients [25,26]. As therapeutic agents, the mode of action of CDs and their derivatives can occur in two ways.…”

Section: Modes Of Action Of Cdsmentioning

confidence: 99%

“…Phospholipids, acting as acetylcholine precursor, would counteract the loss of cholinergic neurons responsible for impaired cognition in AD patients. The chitosan/phospholipid/β-CD microspheres were tested in vivo in rats modeling AD following Aβ [25][26][27][28][29][30][31][32][33][34][35] injection into the hippocampus. In these animals, learning and memory were improved according to Morris water maze test data compared to untreated littermates.…”

Section: Alzheimer's Diseasementioning

confidence: 99%

Cyclodextrins as Emerging Therapeutic Tools in the Treatment of Cholesterol-Associated Vascular and Neurodegenerative Diseases

et al. 2016

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Cardiovascular diseases, like atherosclerosis, and neurodegenerative diseases affecting the central nervous system (CNS) are closely linked to alterations of cholesterol metabolism. Therefore, innovative pharmacological approaches aiming at counteracting cholesterol imbalance display promising therapeutic potential. However, these approaches need to take into account the existence of biological barriers such as intestinal and blood-brain barriers which participate in the organ homeostasis and are major defense systems against xenobiotics. Interest in cyclodextrins (CDs) as medicinal agents has increased continuously based on their ability to actively extract lipids from cell membranes and to provide suitable carrier system for drug delivery. Many novel CD derivatives are constantly generated with the objective to improve CD bioavailability, biocompatibility and therapeutic outcomes. Newly designed drug formulation complexes incorporating CDs as drug carriers have demonstrated better efficiency in treating cardiovascular and neurodegenerative diseases. CD-based therapies as cholesterol-sequestrating agent have recently demonstrated promising advances with KLEPTOSE ® CRYSMEB in atherosclerosis as well as with the 2-hydroxypropyl-β-cyclodextrin (HPβCD) in clinical trials for Niemann-Pick type C disease. Based on this success, many investigations evaluating the therapeutical beneficial of CDs in Alzheimer's, Parkinson's and Huntington's diseases are currently on-going.

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“…For NSAIDs, STs are only recommended for reactions pyrazolones reactions (grade of recommendation, C) [87,124]. STs can be used to diagnose hypersensitivity reactions to hypnotic drugs [125], sugammadex [126], local anaesthetics [89], and dyes [127] (grade of recommendation, C). The value of STs with opioids such as morphine to detect perioperative reactions is unclear, due to their capacity to induce non-specific histamine release (grade of recommendation, C) [116].…”

Section: Skin Testsmentioning

confidence: 99%

Practical Guidelines for Perioperative Hypersensitivity Reactions

Laguna¹,

Archilla²,

Doña³

et al. 2018

J Investig Allergol Clin Immunol

105

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Perioperative hypersensitivity reactions constitute a first-line problem for anesthesiologists and allergists, so it is advisable that hospitals have a consensus protocol for the diagnosis and management of these reactions. However, this kind of protocols is not present in many hospitals, leading to problems in treatment, the communication of incidents and subsequent etiological diagnosis. In this document we present a systematic review of the available scientific evidence and provide general guidelines for the management of acute episodes and Resumen:Las reacciones de hipersensibilidad perioperatorias constituyen un problema de primera línea para los anestesiólogos y alergólogos, por lo que es recomendable que los hospitales tengan un protocolo de consenso para el diagnóstico y el tratamiento de estas reacciones. Sin embargo, este tipo de protocolos no está presente en muchos hospitales, lo que conlleva problemas en el tratamiento, la comunicación de incidentes y el posterior diagnóstico etiológico. Este documento ha sido creado por miembros del Comité de Alergia a Medicamentos de la Sociedad Española de Alergia e Inmunología Clínica (SEAIC) en colaboración con miembros de la Sociedad Española de Anestesia (SEDAR). Se ha realizado una revisión sistemática de la evidencia científica disponible y se proporcionan pautas generales para el manejo de episodios agudos y para la derivación de pacientes con reacciones de hipersensibilidad perioperatoria a los Servicios de Alergología. Se propone un algoritmo práctico para el diagnóstico etiológico y se brindan recomendaciones para el manejo de pacientes con reacciones alérgicas perioperatorias.

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Three suspected cases of sugammadex-induced anaphylactic shock

Cited by 59 publications

References 17 publications

Effect of sugammadex and neostigmine on tracheal muscle: In vitro study

Effect of sugammadex and neostigmine on tracheal muscle: In vitro study

Cyclodextrins as Emerging Therapeutic Tools in the Treatment of Cholesterol-Associated Vascular and Neurodegenerative Diseases

Practical Guidelines for Perioperative Hypersensitivity Reactions

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