Reversal of a rocuronium-induced grade IV anaphylaxis via early injection of a large dose of sugammadex

Abstract

Very early administration of a large dose of sugammadex may be an effective treatment for rocuronium-induced anaphylaxis.

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“…The case reported by Barthel et al 12 was a typical example of the need to inject a sufficient dose when firstly, a high dose of rocuronium has been used (0.8 mgÁkg -1 in this case), and also, the time to onset of allergic symptoms following the injection of rocuronium was immediate. This is also consistent with the case of Conte et al, 11 where the authors administered sugammadex 14 mgÁkg -1 six minutes after a dose of rocuronium 0.6 mgÁkg -1 , resulting in correction of the hypotension within approximately one minute.…”

“…11 The case described herein is different from those in previous reports in that sugammadex was administered much earlier in the course of the anaphylactic reaction, that is, as soon as six minutes after the rocuronium had been injected, and four minutes after injection of the first ineffective doses of epinephrine. 11 How can we explain these positive results? In the absence of a controlled trial, it is not possible to conclude that sugammadex is effective.…”

“…The natural course of the reported cases of severe anaphylactic shock (grades III and IV) may have been trending toward improvement, regardless of the subsequent administration of sugammadex. However, Conte et al 11 described a very rapid deterioration of the cardiovascular status despite the injection of epinephrine. They reported a nearly immediate restitutio ad integrum to a stable hemodynamic status following sugammadex injection.…”

“…The first-line treatment to administer without delay obviously remains titrated doses of epinephrine. 3 Alongside this symptomatic treatment, however, as suggested by Conte et al 11 and others (Table), very early administration of high-dose sugammadex could be a novel therapeutic approach intended to rapidly decrease the free fraction of rocuronium once serious anaphylactic symptoms occur. The overall risk-benefit ratio of this strategy appears to favour sugammadex administration in situations with potentially life-threatening consequences.…”

“…Dans ce numéro du Journal un nouveau cas clinique positif est rapporté. 11 Le Tableau de l'article résume les éléments clés de la prise en charge des différents cas cliniques illustratifs publiés à ce jour. Par rapport aux précédents, le cas décrit dans ce numéro du Journal se démarque par une administration de sugammadex très précoce, soit six minutes après l'injection du rocuronium et quatre minutes après l'injection des premières doses d'adrénaline, qui s'étaient montrées peu efficaces.…”