Two Cases of Rocuronium-Induced Anaphylaxis/Anaphylactic Shock Successfully Treated With Sugammadex

Abstract

While anaphylaxis can occur at any time during general anesthesia, 90% of cases occur at induction of anesthesia. As several drugs are administered simultaneously at this time, it is difficult to identify the causative agent. However, it has been found that rocuronium is the most common drug associated with perioperative anaphylaxis. We treated 2 cases of patients who were administered sugammadex for anaphylactic symptoms thought to be caused by rocuronium, after which the anaphylactic symptoms disappeared. One of the most important aspects of treating anaphylactic shock is improving hemodynamics. If signs indicating circulatory collapse are observed, epinephrine should be administered immediately. However, because rocuronium was suspected of being the causative agent, and taking the patients' clinical course over time into consideration, sugammadex was initially administered. As a result, symptoms improved. Therefore, we believe that the administration of sugammadex may be effective for treating anaphylaxis caused by rocuronium and also help in identifying the causative agent.

A systematic review and meta-analysis of the effect of different doses of rocuronium for general anesthesia on thyroid surgery

“…The incidence of thyroid diseases is increasing, and surgery is the most common treatment (22)(23)(24). In case of recurrent laryngeal nerve injury, should be done immediately.…”

Retrospective evaluation of the effects of Sugammadex and Neostigmine on the IgE and Eosinophil Cationic Protein in Morbid Obese Patients

“…In contrast, hydrophobic molecules formed by gamma-cyclodextrin may penetrate body tissues may cause the release of active molecules. Anaphylaxis reactions with sugammadex-rocuronium complex [ 4 , 21 , 22 ] as well as anaphylaxis reactions with rocuronium [ 23 ] are available in the literature, which leads to confusion as to which is the real trigger in anaphylaxis. In the literature, the anaphylaxis reaction associated with sugammadex is not IgE/IgG-mediated [ 24 ].…”

Role of sugammadex in the treatment of anaphylaxis due to rocuronium in children: Extrapolation from adult and animal reports

“…The literature on this subject includes case reports involving a single patient, case series of 2–3 patients where sugammadex was successful, a few case reports where sugammadex was not successful, and a larger retrospective study involving cases reported to the Western Australian Anesthetic Drug Reaction clinic (see below). The various anecdotal reports, the first of which was published in 2011, outlining the potential successful use of sugammadex in ameliorating or reversing the clinical signs and symptoms following an allergic reaction to rocuronium, are summarized in Table 1 9–24 . These reports include a total of 21 adult patients in whom sugammadex was administered following a suspected allergic reaction to rocuronium.…”

“…Postoperative support for the diagnosis of an allergic reaction to rocuronium was not obtained in all patients, but in several included an elevated serum tryptase or histamine level, immunoassays identifying IgE antibody to rocuronium basophil activation in response to rocuronium, or positive intradermal skin testing. One interesting report noted positive skin testing to rocuronium and negative skin testing to sugammadex and the rocuronium‐sugammadex complex 21 …”