Cardiac arrest following anaphylaxis induced by sugammadex in a regional hospital

Obara, Shinju; Kurosawa, Shin; Honda, Jun; Oishi, Rieko; Iseki, Yuzo; Murakawa, Masahiro

doi:10.1016/j.jclinane.2017.11.003

Cited by 20 publications

(29 citation statements)

References 2 publications

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“…Plasma tryptase concentrations were slightly raised during the event, but a subsequent intradermal skin testing showed a positive reaction only to undiluted sugammadex. 18 Similar reports have been noted in patients with preexisting cardiac disease. For instance, a 10-yr-old patient who had a heart transplant underwent cardiac catheterisation under general anaesthesia.…”

supporting

confidence: 65%

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Sugammadex-induced bradycardia and asystole: how great is the risk?

Hunter

Naguib

2018

British Journal of Anaesthesia

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supporting

confidence: 65%

“…Similar case reports continue to appear in the anaesthesia literature. 18 In 2018, a patient who was being treated for atrial fibrillation with bisoprolol and underwent osteosynthesis was reported. After rocuronium peroperatively, he was given sugammadex 200 mg at the end of surgery.…”

mentioning

confidence: 99%

Sugammadex-induced bradycardia and asystole: how great is the risk?

Hunter

Naguib

2018

British Journal of Anaesthesia

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“…We see that the majority of the sugammadex-related cardiac collapses reported in the literature are due to anaphylaxis. 8,9 As the patient did not have any symptoms that are similar to the cases in the literature or that suggest anaphylaxis such as angioedema, skin rash, sudden hypotension, and as variant angina diagnosis was made after performing coronary angiography immediately after the VF, we do not attribute the clinical picture to anaphylaxis.…”

Section: Discussionmentioning

confidence: 80%

Sudden Cardiac Collapse After Sugammadex Administration in a Patient with First Variant Angina Attack

Hacıbeyoğlu¹,

Arıcan²,

Erol³

et al. 2019

Turkiye Klinikleri J Anest Reanim

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“…Sugammadex has been reported to be more efficacious and safer than other drugs, such as Neostigmine, with lower incidence of common adverse drug reactions (ADRs) such as postoperative nausea and vomiting, dry mouth, tachycardia and dizziness [1][2][3]. However, the incidence of significant ADRs is almost similar between Sugammadex and Neostigmine: hypersensitivity, anaphylaxis [4,5] and, more recently, severe cardiac events such as coronary vasospasm and acute coronary syndrome [6][7][8], AV block [9], hypotension [10] and bradycardia with or without cardiac arrest [11][12][13][14] are described.…”

Section: Introductionmentioning

confidence: 99%

Severe Hypotension, Bradycardia and Asystole after Sugammadex Administration in an Elderly Patient

et al. 2021

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Background and Objectives: Sugammadex is a modified γ-cyclodextrin largely used to prevent postoperative residual neuromuscular blockade induced by neuromuscular aminosteroid blocking agents. Although Sugammadex is considered more efficacious and safer than other drugs, such as Neostigmine, significant and serious complications after its administration, such as hypersensitivity, anaphylaxis and, more recently, severe cardiac events, are reported. Case presentation: In this report, we describe the case of an 80-year-old male with no medical history of cardiovascular disease who was scheduled for percutaneous nephrolithotripsy under general anesthesia. The intraoperative course was uneventful; however, the patient developed a rapid and severe hypotension, asystole and cardiac arrest after Sugammadex administration. Spontaneous cardiac activity and hemodynamic stability was restored with pharmacological therapy and chest compression. The patient was stabilized and discharged uneventfully on postoperative day 10. Conclusions: The potential causes of cardiac arrest after Sugammadex administration have been carefully considered, yet all indications point to Sugammadex as the direct causative agent. On the basis of laboratory and clinical tests, we can exclude among the cause of bradycardia, Kounis syndrome, acute myocardial infarction, coronary spasm and other arrhythmias, but not anaphylaxis. Although Sugammadex is considered an increasingly important option in the prevention of postoperative residual neuromuscular blockade, anesthesiologists should consider it a causative agent of cardiac arrest during surgery. This case highlights the necessity of increased pharmacovigilance and further studies to examine Sugammadex safety and mechanism through which it may cause severe bradycardia, hypotension and cardiac arrest.

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Cardiac arrest following anaphylaxis induced by sugammadex in a regional hospital

Cited by 20 publications

References 2 publications

Sugammadex-induced bradycardia and asystole: how great is the risk?

Sugammadex-induced bradycardia and asystole: how great is the risk?

Sudden Cardiac Collapse After Sugammadex Administration in a Patient with First Variant Angina Attack

Severe Hypotension, Bradycardia and Asystole after Sugammadex Administration in an Elderly Patient

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