A suspected case of coronary vasospasm induced by anaphylactic shock caused by rocuronium-sugammadex complex

Okuno, Ayako; Matsuki, Yuka; Tabata, Mari; Shigemi, Kenji

doi:10.1016/j.jclinane.2018.03.017

Cited by 22 publications

(16 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Several cases of Kounis syndrome caused by midazolam [15], morphine [16], and rocuronium [17] have been reported. One article described Kounis syndrome probably caused by the rocuronium-sugammadex complex, although this case did not present bradycardia but tachycardia [18]. No published case report regarding sugammadex-induced bradycardia has mentioned Kounis syndrome as a possible cause of bradycardia.…”

Section: Discussionmentioning

confidence: 83%

A rare case of atropine-resistant bradycardia following sugammadex administration

et al. 2020

View full text Add to dashboard Cite

Background: Profound bradycardia caused by sugammadex has been reported, although its mechanism is unclear. Herein, we suggest a possible culprit for this phenomenon. Case presentation: A 50-year-old woman without comorbidity except mild obesity underwent a transabdominal hysterectomy and right salpingo-oophorectomy. After surgery, sugammadex 200 mg was intravenously administered. Approximately 4 min later, her heart rate decreased to 36 bpm accompanied by hypotension (41/20 mmHg) and ST depression in limb lead electrocardiogram (ECG). Atropine 0.5 mg was injected intravenously without improving the hemodynamics. Intravenous adrenaline 0.5 mg was added despite the lack of signs suggesting allergic reactions. Her heart rate and blood pressure quickly recovered and remained stable thereafter, although 12-lead ECG taken 1 h later still showed ST depression. Conclusions: In this case, the significant bradycardia appeared attributable to coronary vasospasm (Kounis syndrome) induced by sugammadex, considering the ECG findings and high incidence of anaphylaxis due to sugammadex.

show abstract

Section: Discussionmentioning

confidence: 83%

A rare case of atropine-resistant bradycardia following sugammadex administration

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Apart from hypersensitivity reactions to either sugammadex or rocuronium, it has been proposed that the rocuroniumsugammadex complex in itself is able to provoke an allergic reaction due to a change of its immunological properties [77,78]. Finally, the administration of sugammadex in the treatment of rocuronium induced anaphylaxis remains unclear.…”

Section: Anaphylaxis and Hypersensitivitymentioning

confidence: 99%

Safety of sugammadex for reversal of neuromuscular block

Honing

Martini

Bom³

et al. 2019

Expert Opinion on Drug Safety

View full text Add to dashboard Cite

Introduction: Sugammadex is a modified cyclodextrin that is able to reverse neuromuscular block induced by aminosteroidal neuromuscular blocking drugs. Compared to reversal with neostigmine, it reverses neuromuscular block quicker and more predictable and without cholinergic side effects. However, there have been concerns about sugammadex ability to bind other drugs and its effects on QT interval and clotting times. In addition, sugammadex might induce hypersensitivity reactions more frequently than initially anticipated. This review summarizes current evidence with regard to these and other safety aspects of sugammadex. Areas covered: This review provides an overview of the efficacy of sugammadex in various patient populations, evaluates potential interactions with other drugs and discusses adverse effects and reactions that have been reported in the literature. Expert opinion: Sugammadex quickly reverses aminosteroid neuromuscular block with less side effects compared to neostigmine. As such, it has the potential to significantly reduce the incidence of residual neuromuscular block and to improve postoperative pulmonary outcome. Current safety concerns mainly focus on hypersensitivity reactions and cardiac arrhythmias. Although the absolute risk for these events is low, ongoing vigilance and research in this area are needed.

show abstract

“…In some cases including this report, the skin tests for sugammadex and sugammadex-rocuronium complex were performed at the same time from the beginning [ 4 , 5 ]. In other cases, the skin test for the sugammadex-rocuronium complex was performed later to find out the possible allergenic antigen after negative reaction to sugammadex [ 2 , 11 ]. Nakanishi et al [ 4 ] mixed equal volumes of sugammadex 100 mg/ml and rocuronium 10 mg/ml and made a serial dilution (1 : 10, 1 : 100, and 1 : 1000), yielding the ratio of sugammadex to rocuronium in the mixture 2.8 : 1 on a molar basis.…”

Section: Discussionmentioning

confidence: 99%

Anaphylaxis induced by sugammadex and sugammadex-rocuronium complex -a case report-

Choi

Han

Kwak

et al. 2020

Korean J Anesthesiol

View full text Add to dashboard Cite

Background: In sugammadex-induced anaphylaxis, sugammadex and/or sugammadex-rocuronium complex have possible allergenic epitope. Case: We report a case of sugammadex-induced anaphylaxis during general anesthesia in a 60-year-old male undergoing orthopedic hand surgery, manifesting as profound hypotension and urticaria. The timing of onset was closely associated with sugammadex administration. The patient recovered after extensive therapy including fluid, epinephrine, other vasopressors, steroid, and antihistamine administration. By intradermal skin test which was done at four weeks after anaphylaxis, we confirmed positive reactions to both sugammadex and sugammadex-rocuronium complex. Conclusions: This is a rare case of sugammadex-induced anaphylaxis that both sugammadex and sugammadex-rocuronium complex were confirmed as allergenic epitopes.

show abstract

A suspected case of coronary vasospasm induced by anaphylactic shock caused by rocuronium-sugammadex complex

Cited by 22 publications

References 4 publications

A rare case of atropine-resistant bradycardia following sugammadex administration

A rare case of atropine-resistant bradycardia following sugammadex administration

Safety of sugammadex for reversal of neuromuscular block

Anaphylaxis induced by sugammadex and sugammadex-rocuronium complex -a case report-

Contact Info

Product

Resources

About