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SummaryWe report the first published case of confirmed anaphylaxis to sugammadex in a UK hospital. The patient was given a bolus of sugammadex at the end of surgery. Four minutes later, he developed hypotension and a widespread erythematous rash. Multiple epinephrine boluses were administered and a continuous intravenous infusion of epinephrine commenced. The patient later reported auditory awareness, which occurred while the diagnosis of anaphylaxis was being made and initial treatment initiated. Serial serum tryptase levels were consistent with a type I hypersensitivity reaction. Skin prick and intradermal testing were performed 6 months later confirming allergy to sugammadex. This case restates the potential for hypersensitivity reactions to develop following the administration of sugammadex and makes clinicians aware that such reactions may require prolonged treatment with intravenous infusions of epinephrine. Finally, this case highlights the importance of maintaining or re-establishing anaesthesia while managing the emergent situation in order to avoid unintentional awareness.

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A method of preparing antigen for Newcastle hemagglutination-inhibition (HI) tests is described; polyethylene glycol precipitation is used for the virus concentration. The virus was inactivated with either formalin or beta-propiolactone. Glycerin was used to stabilize the hemagglutinin activity of the antigen. The stability, uninfectivity, and slow eluting features of the antigen should aid in obtaining accurate HI results without the risks inherent in the use of live virus.

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